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Case Report
Uncorrected Proof. Available online 12 April 2024
Combined thalamic and pallidal deep brain stimulation in diabetic hemiballism/hemichorea
Estimulación Cerebral Profunda Tálamica y Pálida Combinada en el Hemibalismo/Hemicorea Diabético
Onur Ozturka,
Corresponding author
onurozturk.ial@gmail.com

Corresponding author at: Acibadem Taksim Hospital, Inonu Neighbourhood Nizamiye Street N: 9/1, Sisli/Istanbul, Turkey.
, Nihan Hande Akcakayab, Mehmet Osman Akcakayac
a Department of Neurosurgery, Acibadem Taksim Hospital, Istanbul, Turkey
b Department of Neurology, Demiroglu Bilim University Medicine Faculty, Istanbul, Turkey
c Department of Neurosurgery, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
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Abstract

Hemiballism/Hemichorea (HH) is a hyperkinetic movement disorder observed mostly after cerebrovascular diseases in elderly patients. Even though the improvement in symptoms would be maintained without treatment, in rare cases, lesioning or DBS (deep brain stimulation) surgery provide a chance on relieving the severe involuntary movements. HH is a more rarely reported entity as a diabetic complication and we encountered very few cases treated with surgical intervention for diabetic HH. A 75-year-old female patient with type-II diabetes mellitus was admitted for left-sided disabling involuntary movement despite being medically treated for six months. A GPi (globus pallidus internus) and thalamic Vim (ventral intermediate) nucleus targeted DBS surgery was performed. Complete resolution was achieved with combined stimulation at 1.7 mA of thalamic Vim nucleus and 2.4 mA of GPi. Combined stimulation of thalamic Vim nucleus and GPi resulted in an effective treatment method for HH secondary to diabetes in our case. Even if the rarity of the cases treated surgically withholds us to come to a certain conclusion, it provides a new option to treat HH to our experience.

Keywords:
Deep brain stimulation
Hemiballism-Hemichorea
Diabetes mellitus
Movement disorder
Abbreviations:
CT
DBS
DM
GABA
GPi
HH
Hz
mA
MRI
µs
STN
Vim
VL
VO
Resumen

El hemibalismo/hemicorea (HH) es un trastorno del movimiento hipercinético que se observa principalmente después de enfermedades cerebrovasculares en pacientes de edad avanzada. A pesar de que la mejora de los síntomas se mantendría sin tratamiento, en casos raros, la cirugía de lesional o ECP (estimulación cerebral profunda) brindan la posibilidad de aliviar los movimientos involuntarios severos. La HH es una entidad notificada con menor frecuencia como complicación de la diabetes y encontramos muy pocos casos tratados con intervención quirúrgica para la HH diabética. Paciente mujer de 75 años con diabetes mellitus tipo II ingresó por movimientos involuntarios incapacitantes en el lado izquierdo a pesar de haber recibido tratamiento médico durante seis meses. Se realizó una cirugía de ECP dirigida al núcleo GPi (globus pallidus internus) y Vim (ventral intermediate) talámico. Se logró una resolución completa con estimulación combinada a 1.7 mA del núcleo talámico Vim y 2.4 mA de GPi. La estimulación combinada del núcleo Vim talámico y GPi resultó en un método de tratamiento eficaz para la HH secundaria a diabetes en nuestros caso. Aunque la rareza de los casos tratados quirúrgicamente nos impide llegar a una conclusion cierta, proporciona una nueva opción para tratar la HH resistente a nuestra experiencia.

Palabras clave:
Estimulación cerebral profunda
Hemibalismo-Hemicorea
Diabetes mellitus
Trastorno del movimiento

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