title: Drowning hazard with deep brain stimulation: case report.
abstract: The caudal zona incerta target within the posterior subthalamic area is an investigational site for deep brain stimulation (DBS) in Parkinson disease (PD) and tremor. The authors report on a patient with tremor-predominant PD who, despite excellent tremor control and an otherwise normal neurological examination, exhibited profound difficulty swimming during stimulation. Over the last 20 years, anecdotal reports have been received of 3 other patients with PD who underwent thalamic or pallidal lesioning or DBS surgery performed at the authors' center and subsequently drowned. It may be that DBS puts patients at risk for drowning by specifically impairing their ability to swim. Until this finding can be further examined in larger cohorts, patients should be warned to swim under close supervision soon after DBS surgery.
authors.affiliation: School of Surgery, University of Western Australia;|Neurosurgical Service of Western Australia, Sir Charles Gairdner Hospital;
authors.forename: Omar K
authors.initials: OK
authors.lastname: Bangash
authors.affiliation: Neurosurgical Service of Western Australia, Sir Charles Gairdner Hospital;
authors.forename: Megan
authors.initials: M
authors.lastname: Thorburn
authors.affiliation: School of Surgery, University of Western Australia;|Department of Physiotherapy, Sir Charles Gairdner Hospital;
authors.forename: Jimena
authors.initials: J
authors.lastname: Garcia-Vega
authors.affiliation: Western Australian Neuroscience Research Institute;
authors.forename: Susan
authors.initials: S
authors.lastname: Walters
authors.affiliation: Western Australian Neuroscience Research Institute;|Department of Neurology, Sir Charles Gairdner Hospital; and.
authors.forename: Rick
authors.initials: R
authors.lastname: Stell
authors.affiliation: Neuropsychiatry Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.
authors.forename: Sergio E
authors.initials: SE
authors.lastname: Starkstein
authors.affiliation: School of Surgery, University of Western Australia;|Neurosurgical Service of Western Australia, Sir Charles Gairdner Hospital;
authors.forename: Christopher R P
authors.initials: CR
authors.lastname: Lind
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D004332:Drowning / Q000209:etiology* / Q000503:physiopathology*; D004567:Electrodes, Implanted; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D010300:Parkinson Disease / Q000503:physiopathology* / Q000628:therapy*; D013550:Swimming / Q000502:physiology*; D065820:Zona Incerta / Q000503:physiopathology*
keywords: DBS = deep brain stimulation; MDS-UPDRS-III = Movement Disorder Society-Unified Parkinson’s Disease Rating Scale Part III (motor section); PD = Parkinson disease; PSA = posterior subthalamic area; Parkinson disease; STN = subthalamic nucleus; cZI = caudal zona incerta; deep brain stimulation; drowning; functional neurosurgery; posterior subthalamic area; swimming