Hyperhidrosis associated with subthalamic deep brain stimulation in Parkinson's disease: Insights into central autonomic functional anatomy.
BACKGROUND
There is limited evidence regarding the precise location and connections of thermoregulatory centers in humans. We present two patients managed with subthalamic nucleus (STN) Deep Brain Stimulation (DBS) for motor fluctuations in PD that developed reproducible hyperhidrosis with high frequency DBS.


OBJECTIVE
To describe the clinical features and analyze the location of the electrodes leading to autonomic activation in both patients.


METHODS
We retrospectively assessed the anatomical localization, electrode programming settings and effects of unilateral STN DBS leading to hyperhidrosis.


RESULTS
Unilateral stimulation of anterior and medially located contacts within the STN and zona incerta (Zi) caused bilateral, consistent, reproducible, and reversible sweating in our patients. Adequate control of motor symptoms without autonomic side effects was accomplished with alternative programming settings.


CONCLUSIONS
Stimulation of the medial Zi and medial and anterior STN causes hyperhidrosis in a pattern similar to that described in primates and rats. We speculate that central autonomic fibers originating in the lateral hypothalamic area project laterally to the ventral/medial Zi and then to brainstem nuclei following an medial and posterior trajectory in relationship to STN.
Department of Neurology, Albany Medical College, Albany, NY, United States. Electronic address: Ramirea@mail.amc.edu.
Adolfo
A
Ramirez-Zamora
Department of Neurosurgery, Albany Medical College, Albany, NY, United States.
Heather
H
Smith
Department of Neurosurgery, Albany Medical College, Albany, NY, United States.
Youngwon
Y
Youn
Department of Neurology, Albany Medical College, Albany, NY, United States.
Jennifer
J
Durphy
Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, NY, United States.
Damian S
DS
Shin
Department of Neurosurgery, Albany Medical College, Albany, NY, United States.
Julie G
JG
Pilitsis
D000328:Adult; D001341:Autonomic Nervous System / Q000000981:diagnostic imaging / Q000503:physiopathology; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D007839:Functional Laterality; D006801:Humans; D006945:Hyperhidrosis / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000000981:diagnostic imaging / Q000503:physiopathology
Autonomic system; Deep brain stimulation; Hyperhidrosis; Parkinson's disease; Subthalamic nucleus; Sweating; Zona incerta