Turkish Neurosurgery 2022 , Vol 32 , Num 3
Subthalamic Nucleus Deep Brain Stimulation in a Patient with Severe Axial Symptoms and Suboptimal Levodopa Responsive Parkinson's Disease
1Ondokuz Mayıs University, School of Medicine, Neuromodulation Center, Samsun, Turkey
2Erzurum Regional Health Application and Research Hospital, Department of Neurology, Erzurum, Turkey
3Ondokuz Mayıs University, School of Medicine, Department of Neurology, Samsun, Turkey
4Ondokuz Mayıs University, School of Medicine, Department of Neurosurgery, Samsun, Turkey
DOI : 10.5137/1019-5149.JTN.35424-21.3 AIM: Deep brain stimulation (DBS) is a well-established treatment option for improving function and quality of life (QoL) in carefully selected patients with Parkinson?s disease (PD). Patient selection is a crucial step that should be performed by an experienced multidisciplinary team according to the proposed inclusion and exclusion criteria to increase the QoL of patients.

CASE REPORT: A 47-year-old bedridden woman with a 20-year history of PD presented with levodopa-unresponsive tremor and severe axial symptoms. Despite various antiparkinsonian medications, a suboptimal improvement was observed with the levodopa challenge test. After detailed evaluations, she underwent bilateral subthalamic nucleus DBS. During the 2-year follow-up, her axial symptoms improved significantly leading to a better QoL.

CONCLUSION: Although levodopa-resistant axial symptoms are considered a relative contraindication to DBS surgery, this case report demonstrates that with an interdisciplinary approach and an accurate assessment of symptoms, even bedridden and latestage selected PD cases may benefit from DBS. Keywords : Axial symptoms, Deep brain stimulation, Parkinson's disease, Subthalamic nucleus

Corresponding author : Ersoy KOCABICAK, ersoykocabicak@gmail.com