case_images: PMC10473163_01
case_images: Lead locations within the STN. (1a) Top, lateral view of the right STN (orange) and left STN (blue) lead locations within the STN region (green). (1b) Bottom, anterior view of the right STN (orange) and left STN (blue) lead locations within the STN region (green). These locations are relatively ventral and anterior within the target region.
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case_images: PMC10473163_01_tohm-13-1-780-g1.jpg
case_images: F1
case_images: The location of her DBS lead and active contacts were calculated using co-registration of pre-operative volumetric MRI and a post-operative high resolution CT scan (BrainLab Elements, Westchester, IL., USA)) (Figure 1).
case_images: Stimulation induced dyskinesia and response to optimized programming. The patient manifested tremor that was severe when both medication and stimulation were "off". There was a manifested reduction in tremor, but increased dyskinesia in the medication "on", stimulation "off" state and in the medication "off", stimulation "on" state. Following optimization of DBS programming, there was no tremor, but there was mild dyskinesia, in the medication and stimulation "on" state.
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case_images: V1
case_images: The see-saw effect (Figure 2) refers to the frustrating attempts by a clinician to achieve therapeutic equilibrium.
case_images: The See-Saw Dilemma in STN Related Stimulation Induced Dyskinesia. In cases of STN induced SID, the clinician is challenged to balance the see-saw. Small increases in stimulation result in improvement in one symptom (tremor) with worsening in another (dyskinesia). Alternatively, reduction in medication, may lead to worsening of tremor and improvement in dyskinesia. The clinician may apply programming and medication strategies to attempt to balance the see-saw.
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case_images: F2
case_images: Local field potential data acquired while increasing delivered current demonstrated an increase in oscillations in the gamma range, which correlated with dyskinesia (Figure 3).