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Deep Brain Stimulation of the Internal Segment of the Globus Pallidus in Delayed Runaway Dyskinesia
John Graff-Radford, BS;
Kelly D. Foote, MD;
Ramon L. Rodriguez, MD;
Hubert H. Fernandez, MD;
Robert A. Hauser, MD;
Atchar Sudhyadhom, MS;
Christian A. Rosado, BS;
Justin C. Sanchez, PhD;
Michael S. Okun, MD
Arch Neurol. 2006;63:1181-1184.
Background Dyskinesias that occur during a period without medication after embryonic cell transplantation have been commonly reported in double-blind trials; however, to date, they have not been reported in the few patients who participated in open-label pilot studies.
Design Single case observation with preoperative and postoperative data, and intraoperative single-cell physiology.
Patient A patient who underwent embryonic cell transplantation in 1993 as part of the University of South Florida open-label study was referred for evaluation of intractable dyskinesia of the right arm. The dyskinesia was present during evaluation of the patient after a 12-hour period without medication and was clinically disabling. It was manifested as a severe groping movement of the hand. Intraoperative physiologic evaluation revealed decreased firing rates in the internal segment of the globus pallidus.
Results Deep brain stimulation of the internal segment of the globus pallidus resulted in resolution of the dyskinesia.
Conclusion This case highlights the delayed development of runaway dyskinesia after a period without medication as an important potential long-term adverse effect of embryonic cell transplantation in patients with Parkinson disease.
Author Affiliations: Departments of Neurology, University of Florida Movement Disorders Center (Messrs Graff-Radford and Rosado and Drs Rodriguez, Fernandez, and Okun), Neurosurgery, McKnight Brain Institute (Drs Foote and Okun and Mr Sudhyadhom), and Pediatrics (Dr Sanchez), University of Florida, Gainesville; and Department of Neurology, University of South Florida, Tampa (Dr Hauser).
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