Deep brain stimulation of subthalamic nucleus combined with drugs in two patients with Parkinson's disease related neuroleptic malignant syndrome

Abstract

Objective To explore the role of deep brain stimulation of subthalamic nucleus (STN-DBS) in treatment of Parkinson's disease (PD) related neuroleptic malignant syndrome (NMS). Methods The medical history, clinical features, STN-DBS programmed treatment process and treatment results of two patients admitted to our hospital in December 2014 and November 2018 were retrospectively analyzed. Results Two patients with post-operative STN-DBS were evoked by dose-reduced treatment of anti-parkinsonian drugs, and presented with high fever, disorder of consciousness, aggravation of the original parkinsonism, and increase of creatine phosphokinase, which were not correlated with outcomes of infection. After admission, anti-parkinsonian drugs and other supportive therapies were supplemented; STN-DBS modulation were given to improve the symptoms; the final parameters of patient one were the left (C+, 2-, 1-), pulse width 110 μs, frequency 200 Hz, and strength 3.8 V; the right side (C+, 6-, 5-), pulse width 110 μs, frequency 200 Hz, strength 4.4 V; and those of patient two were the left (C+, 3-), pulse width 60 μs, frequency 130 Hz, strength 2.0 V; right side (C+, 6-), pulse width 80 μs, frequency 160 Hz, and strength 2.8 V. Both patients were cured, but their motor function and self-care ability were severely impaired. Conclusion STN-DBS may play an important role in the treatment of PD related NMS. Key words: Parkinson's disease; neuroleptic malignant syndrome; Drug withdrawal; Deep brain stimulation of subthalamic nucleus