Hemichorea or hemiballism has been correlated clinico-anatomically with lesions of the contralateral side, most commonly of the subthalamic nucleus. Hemichorea due to an ipsilateral lesion is extremely rare. We report a case of a 74-year-old man who developed a left sided hemichorea due to a left thalamic infarction. The literature on the rare occurrence of ipsilateral hemichorea/hemiballism is discussed and possible pathomechanisms are reviewed.
Aged ; Dyskinesias ; Humans ; Infarction* ; Subthalamic Nucleus

Hemiballism is a rare hyperkinetic involuntary movement disorder that presents with unilateral forceful, flinging, large amplitude of proximal limbs. The most consistent neuropathological findings in hemiballism are a lesion of the contralateral subthalamic nucleus and pallidosubthalamic tract. However, we experienced a patient with pure hemiballism as isolated manifestation of acute ischemic stroke without other neurological abnormal symptoms such as chorea or dystonia. Brain magnetic resonance image showed acute ischemic stroke in right caudate nucleus but not subthalamic nucleus.
Brain ; Caudate Nucleus ; Chorea ; Dyskinesias* ; Dystonia ; Extremities ; Humans ; Infarction* ; Stroke ; Subthalamic Nucleus

OBJECTIVEThis review examines the evidence that deep brain stimulation (DBS) has extensive impact on nonmotor symptoms (NMSs) of patients with Parkinson's disease (PD).

DATA SOURCESWe retrieved information from the PubMed database up to September, 2015, using various search terms and their combinations including PD, NMSs, DBS, globus pallidus internus (GPi), subthalamic nucleus (STN), and ventral intermediate thalamic nucleus.

STUDY SELECTIONWe included data from peer-reviewed journals on impacts of DBS on neuropsychological profiles, sensory function, autonomic symptoms, weight changes, and sleep disturbances. For psychological symptoms and cognitive impairment, we tried to use more reliable proofs: Random, control, multicenter, large sample sizes, and long period follow-up clinical studies. We categorized the NMSs into four groups: those that would improve definitively following DBS; those that are not significantly affected by DBS; those that remain controversial on their surgical benefit; and those that can be worsened by DBS.

RESULTSIn general, it seems to be an overall beneficial effect of DBS on NMSs, such as sensory, sleep, gastrointestinal, sweating, cardiovascular, odor, urological symptoms, and sexual dysfunction, GPi-DBS may produce similar results; Both STN and Gpi-DBS are safe with regard to cognition and psychology over long-term follow-up, though verbal fluency decline is related to DBS; The impact of DBS on behavioral addictions and dysphagia is still uncertain.

CONCLUSIONSAs the motor effects of STN-DBS and GPi-DBS are similar, NMSs may determine the target choice in surgery of future patients.

Deep Brain Stimulation ; Globus Pallidus ; surgery ; Humans ; Male ; Parkinson Disease ; surgery ; therapy ; Subthalamic Nucleus ; surgery

Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) is a novel therapy developed to treat Parkinson's disease. We report a patient who underwent bilateral DBS of the PPN and subthalamic nucleus (STN). He suffered from freezing of gait (FOG), bradykinesia, rigidity and mild tremors. The patient underwent bilateral DBS of the PPN and STN. We compared the benefits of PPN-DBS and STN-DBS using motor and gait subscores. The PPN-DBS provided modest improvements in the gait disorder and freezing episodes, while the STN-DBS failed to improve the dominant problems. This special case suggests that PPN-DBS may have a unique role in ameliorating the locomotor symptoms and has the potential to provide improvement in FOG.
Deep Brain Stimulation* ; Freezing ; Gait ; Humans ; Hypokinesia ; Parkinson Disease* ; Subthalamic Nucleus ; Tremor ; Weather

Adult ; Deep Brain Stimulation ; Essential Tremor ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Subthalamic Nucleus ; physiology

BACKGROUND: To determine the efficacy and safety of subthalamic nucleus (STN) stimulation in patients with advanced Parkinson's disease (PD). METHODS: In 5 patients with PD, we evaluated the effect of bilateral STN stimula-tion. Using the Unified PD Rating Scale (UPDRS), Clinical Dyskinesia Rating Scale, Activities of Daily Living(ADL) Score and patient's diary, we evaluated the patients before and at one, three and 12 months after surgery. We examined the patients while they were drug "off" and "on". RESULTS: While patients were "off", stimulation induced a signifi-cant reduction in the UPDRS part III score by 46% at 12 months after the operation, compared to the baseline state. During drug "on" state, levodopa-induced dyskinesias were reduced by 88% at 12 months after the operation. Off-peri-od dystonia was reduced by 45% at 12 months after the operation. ADL scores also improved after the stimulation. Patients' diaries showed significant reduction in the "off" period while awake (73% reduction at 12 months). The daily dose of levodopa was reduced by 56% at 12 months after the operation. There was no significant complication related to the surgical procedure or electrical stimulation. CONCLUSIONS: We conclude that STN stimulation is an effective and safe treatment strategy for the patients with advanced PD.
Activities of Daily Living ; Dyskinesias ; Dystonia ; Electric Stimulation ; Humans ; Levodopa ; Parkinson Disease* ; Subthalamic Nucleus*

OBJECTIVE: The purpose of this study is to investigate the effect of ipsilateral subthalamic nucleus(STN) lesioning on the spontaneous behavioral changes and the alteration of neuronal activities of deep cerebral nuclei in the rat parkinsonian model with 6-hydroxydopamine(6-OHDA). METHODS: To identify the spontaneous behavioral changes, apomorphine-induced rotational test and forepaw adjusting step were performed. We subsequently investigated the alteration of neuronal activities in the substantia nigra pars reticulata(SNpr) and globus pallidus(GP), in order to compare them with the behavioral changes in rat parkinsonian models. RESULTS: The STN lesioning in the rat parkinsonian model clearly improved behavioral changes. Compared to the normal control rats, rat PD models exhibited a significant increase in mean firing rates and the percentage of bursting neurons in the STN and SNpr. In the STN-lesioned rat PD models, mean firing rates and the percentage of bursting neurons in the SNpr were reduced and those in the GP increased. CONCLUSION: STN lesioning induced behavior improvement in rat parkinsonian models seems to be consistent with the surgical outcomes of the STN stimulation therapy in advanced Parkinsonn's disease(PD). The alteration of the neuronal activities in the SNpr and GP suggests that these sites are responsible for the improvement of parkinsonian motor symptoms observed following STN lesioning in rat parkinsonian models. The significance of bursting activity in the SNpr and GP remains obscure. Further study is necessary to elucidate the pathophysiological mechanism of PD.
Animals ; Fires ; Globus Pallidus ; Kainic Acid* ; Neurons* ; Oxidopamine* ; Parkinson Disease ; Rats* ; Substantia Nigra ; Subthalamic Nucleus

The recent progress in the basic knowledge of basal ganglia pathways and advances in the techniques of the neuroimaging studies enabled subthalamic deep brain stimulation (STN DBS). In Korea, more than three hundreds and fifty patients with PD have been treated with STN DBS since the first trial at March 2000. STN DBS effectively improves all parkinsonian deficits occurring especially during levodopa 'off' period and decreases the daily 'off' time. The daily requirement of levodopa dosage can be reduced to about half of the preoperative one. The favorable responses to the STN DBS can be maintained even after five years. However, parkinsonian deficits during levodopa 'on' period can not be controlled as effectively as those during the levodopa 'off' period. The axial symptoms including gait disturbance and postural instability during the levodopa 'on' period cannot be improved or even are worsen by STN DBS. Patients aged over 70 frequently show less remarkable improvement of parkinsonian deficits than the younger ones. Therefore, selection of appropriate candidate for STN DBS is the most important factor deciding the outcome of the STN DBS.
Basal Ganglia ; Deep Brain Stimulation* ; Gait ; Humans ; Korea ; Levodopa ; Neuroimaging ; Parkinson Disease* ; Subthalamic Nucleus

Pathological neural activity in subthalamic nucleus (STN) is closely related to the symptoms of Parkinson' s disease. Local field potentials (LFPs) recordings from subthalamic nucleus show that power spectral peaks exist at tremor, double tremor and tripble tremor frequencies, respectively. The interaction between these components in the multi-frequency tremor may be related to the generation of tremor. To study the linear and nonlinear relationship between those components, we analyzed STN LFPs from 9 Parkinson's disease patients using time frequency, cross correlation, Granger casuality and bi-spectral analysis. Results of the time-frequency analysis and cross-frequency correlation analysis demonstrated that the power density of those components significantly decreased as the alleviation of tremor and cross-correlation (0.18-0.50) exists during tremor period. Granger causality of the time-variant amplitude showed stronger contribution from tremor to double tremor components, and contributions from both tremor and double tremor components to triple tremor component. Quadratic phase couplings among these three components were detected by the bispectral approaches. The linear and nonlinear relationships existed among the multi-components and certainly confirmed that the dependence cross those frequencies and neurological mechanism of tremor involved complicate neural processes.
Action Potentials ; Electromyography ; Humans ; Parkinson Disease ; physiopathology ; Subthalamic Nucleus ; physiopathology ; Tremor ; physiopathology

Biballism is an infrequent hyperkinetic disorder characterized by always ceaseless, repetitive, complex, violent involuntary movement involving proximal muscles. Biballism is classically ascribed to ischemic stroke in the subthalamic nucleus or its connections but other causes (infection, toxin, systemic disease) have been reported. Potential pathogenic mechanism include relative dopamlnergic hypersensitivity associated with basal ganglia lesion, impaired synthesis of acetylcholine or aminobutyric acid or undefined effect of hyperosmolarity. We report a case of biballism occurred due to a infarction of left basal ganglia and nonketotic hyperglycemia.
Acetylcholine ; Aminobutyrates ; Basal Ganglia* ; Dyskinesias ; Humans ; Hyperglycemia ; Hypersensitivity ; Infarction ; Muscles ; Stroke ; Stroke, Lacunar* ; Subthalamic Nucleus