Author response: Beware of deep water after subthalamic deep brain stimulation
DanielWaldvogel, Neurologist, University Hospital Zurich
Christian R.Baumann, Neurologist, University Hospital Zurich
Submitted July 22, 2020
We most appreciate the comments of Dr. Sidiropoulos on our article.1 First, the notion of a deep brain stimulation- (DBS) induced task specific dystonia is interesting; however, observing our patients, inter-limb coordination seemed to be the prominent problem, not dystonia. Whether different modes of stimulation make a difference is a very valid question. According to our experience so far, the observed side effect could not be ameliorated through reprogramming. We did not mention the brand of the stimulator because we hypothesize that the observed side effect is related to the procedure, not the brand. We use one of the most commonly used systems.
Three of the 9 reported patients were tremor-dominant.
Dr. Sidiropoulos wonders rightly whether the overall reduction in dopaminergic medication may have played a role in the patients’ lost ability to swim. In this case, we would have expected other motor tasks to deteriorate as well. On the contrary, the good effect of DBS—partially also on axial UPDRS values—allowed for the substantial reduction in Levodopa, suggesting that DBS affects inter-limb coordination differently than Levodopa therapy does. Certainly, the pathophysiology of the observed problem deserves further studies.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Waldvogel D, Baumann-Vogel H, Stieglitz L, Hänggi-Schickli R, Baumann CR. Beware of deep water after subthalamic deep brain stimulation. Neurology 2020;94:39–41.
We most appreciate the comments of Dr. Sidiropoulos on our article.1 First, the notion of a deep brain stimulation- (DBS) induced task specific dystonia is interesting; however, observing our patients, inter-limb coordination seemed to be the prominent problem, not dystonia. Whether different modes of stimulation make a difference is a very valid question. According to our experience so far, the observed side effect could not be ameliorated through reprogramming. We did not mention the brand of the stimulator because we hypothesize that the observed side effect is related to the procedure, not the brand. We use one of the most commonly used systems.
Three of the 9 reported patients were tremor-dominant.
Dr. Sidiropoulos wonders rightly whether the overall reduction in dopaminergic medication may have played a role in the patients’ lost ability to swim. In this case, we would have expected other motor tasks to deteriorate as well. On the contrary, the good effect of DBS—partially also on axial UPDRS values—allowed for the substantial reduction in Levodopa, suggesting that DBS affects inter-limb coordination differently than Levodopa therapy does. Certainly, the pathophysiology of the observed problem deserves further studies.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References