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May 15, 2018; 90 (20) Clinical/Scientific Notes

Functional movement disorders arising after successful deep brain stimulation

David P. Breen, Mohammad Rohani, Elena Moro, Helen S. Mayberg, Mateusz Zurowski, Andres M. Lozano, Alfonso Fasano
First published April 13, 2018, DOI: https://doi.org/10.1212/WNL.0000000000005530
David P. Breen
From the Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (D.P.B., A.F.), Department of Psychiatry (M.Z.), and Department of Neurosurgery (A.M.L.), Toronto Western Hospital, Toronto, Canada; Department of Neurology (M.R.), Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran; Service de Neurologie (E.M.), Centre Hospitalier Universitaire de Grenoble, Grenoble Alpes University, INSERM U1214, Grenoble, France; and the Departments of Neurology and Neurosurgery (H.S.M.), Icahn School of Medicine at Mount Sinai, New York.
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Mohammad Rohani
From the Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (D.P.B., A.F.), Department of Psychiatry (M.Z.), and Department of Neurosurgery (A.M.L.), Toronto Western Hospital, Toronto, Canada; Department of Neurology (M.R.), Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran; Service de Neurologie (E.M.), Centre Hospitalier Universitaire de Grenoble, Grenoble Alpes University, INSERM U1214, Grenoble, France; and the Departments of Neurology and Neurosurgery (H.S.M.), Icahn School of Medicine at Mount Sinai, New York.
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Elena Moro
From the Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (D.P.B., A.F.), Department of Psychiatry (M.Z.), and Department of Neurosurgery (A.M.L.), Toronto Western Hospital, Toronto, Canada; Department of Neurology (M.R.), Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran; Service de Neurologie (E.M.), Centre Hospitalier Universitaire de Grenoble, Grenoble Alpes University, INSERM U1214, Grenoble, France; and the Departments of Neurology and Neurosurgery (H.S.M.), Icahn School of Medicine at Mount Sinai, New York.
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Helen S. Mayberg
From the Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (D.P.B., A.F.), Department of Psychiatry (M.Z.), and Department of Neurosurgery (A.M.L.), Toronto Western Hospital, Toronto, Canada; Department of Neurology (M.R.), Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran; Service de Neurologie (E.M.), Centre Hospitalier Universitaire de Grenoble, Grenoble Alpes University, INSERM U1214, Grenoble, France; and the Departments of Neurology and Neurosurgery (H.S.M.), Icahn School of Medicine at Mount Sinai, New York.
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Mateusz Zurowski
From the Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (D.P.B., A.F.), Department of Psychiatry (M.Z.), and Department of Neurosurgery (A.M.L.), Toronto Western Hospital, Toronto, Canada; Department of Neurology (M.R.), Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran; Service de Neurologie (E.M.), Centre Hospitalier Universitaire de Grenoble, Grenoble Alpes University, INSERM U1214, Grenoble, France; and the Departments of Neurology and Neurosurgery (H.S.M.), Icahn School of Medicine at Mount Sinai, New York.
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Andres M. Lozano
From the Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (D.P.B., A.F.), Department of Psychiatry (M.Z.), and Department of Neurosurgery (A.M.L.), Toronto Western Hospital, Toronto, Canada; Department of Neurology (M.R.), Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran; Service de Neurologie (E.M.), Centre Hospitalier Universitaire de Grenoble, Grenoble Alpes University, INSERM U1214, Grenoble, France; and the Departments of Neurology and Neurosurgery (H.S.M.), Icahn School of Medicine at Mount Sinai, New York.
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Alfonso Fasano
From the Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (D.P.B., A.F.), Department of Psychiatry (M.Z.), and Department of Neurosurgery (A.M.L.), Toronto Western Hospital, Toronto, Canada; Department of Neurology (M.R.), Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran; Service de Neurologie (E.M.), Centre Hospitalier Universitaire de Grenoble, Grenoble Alpes University, INSERM U1214, Grenoble, France; and the Departments of Neurology and Neurosurgery (H.S.M.), Icahn School of Medicine at Mount Sinai, New York.
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Citation
Functional movement disorders arising after successful deep brain stimulation
David P. Breen, Mohammad Rohani, Elena Moro, Helen S. Mayberg, Mateusz Zurowski, Andres M. Lozano, Alfonso Fasano
Neurology May 2018, 90 (20) 931-932; DOI: 10.1212/WNL.0000000000005530

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Deep brain stimulation (DBS) is an effective and established treatment for movement disorders, as well as an emerging treatment for psychiatric disorders. Outcome is influenced by many factors, including patient selection, electrode placement, stimulation parameters, hardware issues, oral medication adjustments, disease progression, and comorbidities. We present another potential complication following DBS surgery that is clinically important and probably underreported—the onset of a new functional movement disorder. In each of the 4 cases described (all of whom were treated at Toronto Western Hospital over a 15-year period), the correct diagnosis led to diagnostic counseling including demonstration of the presence and significance of positive functional signs to the patient. Patient 4 also had a short course of physiotherapy. Resolution of functional symptoms occurred within 3 months in all cases.

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  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received November 4, 2017.
  • Accepted in final form February 12, 2018.
  • © 2018 American Academy of Neurology
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