MEDICAL
IMAGES
Unilateral Hyperhidrosis Improved by Subthalamic Nucleus Deep Brain Stimulation Bilge Kocer, MD,* Emrah Aytac, MD, and Selim Selcuk Comoglu, MD Diskapi Yildirim Beyazit Training and Research Hospital, Division of Neurology
FIG. 1. A: Right side asymmetric hyperhidrosis, staining with a mixture of cornstarch and povidone iodine test during “off” period. B: On 6th month examination, no staining with a mixture of cornstarch and povidone iodine test after STN-DBS when stimulation is “on.”
These images are from a 67-year-old woman who had Parkinson’s disease (PD) for 16 years and a history of right thalamotomy. She had severe motor fluctuations, peak dose dyskinesias and excessive sweating. Excessive sweating was observed on the right-most affected side in the “off” period, (A) and it was significantly reduced in the “on” periods. Following subthalamic nucleus (STN) deep brain stimulation (DBS), the severity of the “off” periods was markedly decreased (UPDRS 35 vs 28 pre- and post-operatively) and motor fluctuations were noticeably reduced. Levodopa dose was decreased from 1500 mg to 200 mg daily and dyskinesias disappeared. The patient reported complete improvement
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*Correspondence to: Bilge Kocer, MD, Yeni Atabilge Sitesi K4 Blok No. 45, Yasamkent/Ankara-Turkey; [email protected] Funding agencies: None. Relevant conflicts of interest/financial disclosures: Nothing to report. Author roles may be found in the online version of this article. This Case Report was presented at 47th Turkish National Congress of Neurology as a poster presentation. Received: 6 February 2013; Revised: 22 September 2013; Accepted: 24 October 2013 Published online 13 November 2013 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/mds.25754
1940
Movement Disorders, Vol. 28, No. 14, 2013
of excessive sweating on the post-operative 6th month (B). We conclude that hyperhidrosis in our patient may have been improved as the result of attenuation of “off” periods and/or by a direct effect of STN-DBS on adjacent structures affecting autonomic functions. This striking case adds to the notion that STN-DBS may also improve nonmotor fluctuations in PD.1
Reference 1.
Ortega-Cubero S, Clavero P, Irurzun C, Gonzalez-Redondo R, Guridi J, Obeso JA, Rodriguez-Oroz M. Effect of deep brain stimulation of the subthalamic nucleus on non-motor fluctuations in Parkinson’s disease: Two-year’ follow-up. Parkinsonism Relat Disord 2013;19:543–547.
IMAGES
Unilateral Hyperhidrosis Improved by Subthalamic Nucleus Deep Brain Stimulation Bilge Kocer, MD,* Emrah Aytac, MD, and Selim Selcuk Comoglu, MD Diskapi Yildirim Beyazit Training and Research Hospital, Division of Neurology
FIG. 1. A: Right side asymmetric hyperhidrosis, staining with a mixture of cornstarch and povidone iodine test during “off” period. B: On 6th month examination, no staining with a mixture of cornstarch and povidone iodine test after STN-DBS when stimulation is “on.”
These images are from a 67-year-old woman who had Parkinson’s disease (PD) for 16 years and a history of right thalamotomy. She had severe motor fluctuations, peak dose dyskinesias and excessive sweating. Excessive sweating was observed on the right-most affected side in the “off” period, (A) and it was significantly reduced in the “on” periods. Following subthalamic nucleus (STN) deep brain stimulation (DBS), the severity of the “off” periods was markedly decreased (UPDRS 35 vs 28 pre- and post-operatively) and motor fluctuations were noticeably reduced. Levodopa dose was decreased from 1500 mg to 200 mg daily and dyskinesias disappeared. The patient reported complete improvement
------------------------------------------------------------
*Correspondence to: Bilge Kocer, MD, Yeni Atabilge Sitesi K4 Blok No. 45, Yasamkent/Ankara-Turkey; [email protected] Funding agencies: None. Relevant conflicts of interest/financial disclosures: Nothing to report. Author roles may be found in the online version of this article. This Case Report was presented at 47th Turkish National Congress of Neurology as a poster presentation. Received: 6 February 2013; Revised: 22 September 2013; Accepted: 24 October 2013 Published online 13 November 2013 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/mds.25754
1940
Movement Disorders, Vol. 28, No. 14, 2013
of excessive sweating on the post-operative 6th month (B). We conclude that hyperhidrosis in our patient may have been improved as the result of attenuation of “off” periods and/or by a direct effect of STN-DBS on adjacent structures affecting autonomic functions. This striking case adds to the notion that STN-DBS may also improve nonmotor fluctuations in PD.1
Reference 1.
Ortega-Cubero S, Clavero P, Irurzun C, Gonzalez-Redondo R, Guridi J, Obeso JA, Rodriguez-Oroz M. Effect of deep brain stimulation of the subthalamic nucleus on non-motor fluctuations in Parkinson’s disease: Two-year’ follow-up. Parkinsonism Relat Disord 2013;19:543–547.
