• World Neurosurg · Aug 2017

    Case Reports

    Choreatic side-effects of deep brain stimulation of the anteromedial subthalamic nucleus for treatment-resistant obsessive-compulsive disorder: a case report.

    • Anne E P Mulders, Albert F G Leentjens, Koen Schruers, Annelien Duits, Linda Ackermans, and Yasin Temel.
    • Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands.
    • World Neurosurg. 2017 Aug 1; 104: 1048.e9-1048.e13.

    BackgroundPatients with treatment-resistant obsessive-compulsive disorder (OCD) are potential candidates for deep brain stimulation (DBS). The anteromedial subthalamic nucleus (STN) is among the most commonly used targets for DBS in OCD.Case DescriptionWe present a patient with a 30-year history of treatment-resistant OCD who underwent anteromedial STN-DBS. Despite a clear mood-enhancing effect, stimulation caused motor side effects, including bilateral hyperkinesia, dyskinesias, and sudden large amplitude choreatic movements of arms and legs when stimulating at voltages greater than approximately 1.5 V. DBS at lower amplitudes and at other contact points failed to result in a significant reduction of obsessions and compulsions without inducing motor side effects. Because of this limitation in programming options, we decided to reoperate and target the ventral capsule/ventral striatum (VC/VS), which resulted in a substantial reduction in key obsessive and compulsive symptoms without serious side effects.ConclusionsChoreatic movements and hemiballismus have previously been linked to STN dysfunction and have been incidentally reported as side effects of DBS of the dorsolateral STN in Parkinson disease (PD). However, in PD, these side effects were usually transient, and they rarely interfered with DBS programming. In our patient, the motor side effects were persistent, and they made optimal DBS programming impossible. To our knowledge, such severe and persistent motor side effects have not been described previously for anteromedial STN-DBS.Copyright © 2017 Elsevier Inc. All rights reserved.

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