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

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

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

BACKGROUND: We aimed to investigate the possible factors determining reduction of dopaminergic drugs in patients who received bilateral subthalamic nucleus (STN) deep brain stimulation (DBS). METHODS: We studied 33 consecutive Parkinson's disease (PD) patients who underwent bilateral STN DBS between March 2002 and April 2006. Patients were assessed at baseline and 6 months and 1 year after surgery. RESULTS: The dose of dopaminergic drugs was significantly decreased by 16.5% (p<0.05) and 14.9% (p<0.05), at post op 6 months and 12 months respectively. The reduction rate of dopaminergic drugs after bilateral STN DBS was positively correlated with the dopaminergic drug dosage at baseline (p<0.05) and was negatively correlated with the scores of "off"-period UPDRS II (p<0.05), III (p<0.001), and total UPDRS (p<0.001) at baseline. The difference of UPDRS scores between "on" and "off" periods on the levodopa challenge test was negatively correlated with the reduction rate of dopaminergic drug dosage after bilateral STN DBS (p<0.001). CONCLUSIONS: It is likely that the main determining factors for the reduction of dopaminergic drug dosages after bilateral STN DBS in advanced PD are the UPDRS III score during "off" periods, difference of the UPDRS III score between "on" and "off" periods on the levodopa challenge test and dose of dopaminergic drugs at baseline.
Deep Brain Stimulation ; Dopamine Agents ; Humans ; Levodopa ; Parkinson Disease ; Subthalamic Nucleus

Hemiballism is a ballistic, involuntary movement disorder, usually of a sudden onset, an often occurs due to encephalomalasic lesion, mostly an infarction, of deep structure of contralateral cerebral hemisphere, rarely by a small hemorrhage. The lesion site is thought to be mainly subthalamic nucleus contralateral to the abnormal movement. But there have been several reports on hemiballism without involvement of subthalmic nucleus throughout the world. We report a case of acute vascular hemiballism occurred due to a small hemorrhage with involvement of left putamen and globus pallidus, which was demonstrated by computed tomography and magnetic resonance imaging study of brain.
Brain ; Cerebrum ; Dyskinesias* ; Globus Pallidus ; Hemorrhage ; Infarction ; Magnetic Resonance Imaging ; Putamen ; Subthalamic Nucleus

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*

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

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

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