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J. Neurol. Neurosurg. Psychiatr. · Jan 2024
Case ReportsUncovering neuroanatomical correlates of impaired coordinated movement after pallidal deep brain stimulation.
- Brendan Santyr, Aaron Loh, Artur Vetkas, Dave Gwun, Wilson Kw Fung, Shakeel Qazi, Jurgen Germann, Alexandre Boutet, Can Sarica, Andrew Yang, Gavin Elias, Suneil K Kalia, Alfonso Fasano, and Andres M Lozano.
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
- J. Neurol. Neurosurg. Psychiatr. 2024 Jan 11; 95 (2): 167170167-170.
BackgroundThe loss of the ability to swim following deep brain stimulation (DBS), although rare, poses a worrisome risk of drowning. It is unclear what anatomic substrate and neural circuitry underlie this phenomenon. We report a case of cervical dystonia with lost ability to swim and dance during active stimulation of globus pallidus internus. We investigated the anatomical underpinning of this phenomenon using unique functional and structural imaging analysis.MethodsTesla (3T) functional MRI (fMRI) of the patient was used during active DBS and compared with a cohort of four matched patients without this side effect. Structural connectivity mapping was used to identify brain network engagement by stimulation.ResultsfMRI during stimulation revealed significant (Pbonferroni<0.0001) stimulation-evoked responses (DBS ON
ConclusionsThese stimulation-induced impairments are likely a manifestation of a broader deficit in interlimb coordination mediated by stimulation effects on the SMA. This neuroanatomical underpinning can help inform future patient-specific stimulation and targeting.© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ. Notes
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