“Two odd targets” strategy in deep brain stimulation for Parkinson's disease with unilateral levodopa-induced dystonia

Abstract

A 49-year-old man with Parkinson's disease developed wearing-off and levodopa-induced dyskinesia with a dystonic component in the left upper limb. He decided to undergo deep brain stimulation. Asymmetric targets were chosen; for the right side, globus pallidus interna was selected to improve the dystonia in his left upper extremity, and for the left side, the subthalamic nucleus, which had the expected benefit of reducing the patient's medications, was selected. After the surgery, the levodopa-induced dystonia in his left arm was markedly improved, and the levodopa equivalent dose was reduced by 21.4%. The present case suggests that deep brain stimulation with a different target in the left and right hemisphere could be an effective therapeutic option for patients with asymmetric symptoms.