Deep brain stimulation for Parkinson’s disease and involuntary movements: Note to avoid a false-negative indication

Abstract

Deep brain stimulation (DBS) is an established procedure to treat symptoms of Parkinson’s disease (PD)and involuntary movements, even though they are not well-respond to medical therapies. In conjunction with the progress of a supporting system for stereotactic surgery and DBS devices, a number of treatment results and its evidence have been accumulated. Here, we show the increasing use of DBS for the treatment of movement disorders, discussing certain cases that might be excluded from surgical intervention based on conventional empirical diagnosis. DBS is generally ineffective for levodopa-unresponsive motor symptoms. However, in such cases with limited dose of anti-parkinsonian medications, motor function may be improved by levodopa-challenge test, even if levodopa responsiveness is lacking with the conventional daily dose. Dystonia can be misdiagnosed as psychogenic movement disorders (PMDs) because patients with dystonia may exhibit atypical tremor-like movements, sensory tricks, and task-specific or unexpected reinforcement of the symptoms. Furthermore, mental diseases often coexist with dystonia. It is considerably difficult to arrive at DBS therapy once the patients have been diagnosed with PMDs. Usefulness of DBS has been shown in relatively rare diseases, including Lance-Adams syndrome, certain neurodegenerative diseases, hemichorea/ballism, Holmes’ tremor, or paroxysmal dyskinesias. The use of DBS for the treatment of movement disorders is increasing. A better understanding of the characteristic symptoms of movement disorders might help identify DBS intervention as a potential treatment.