Unilateral multi-target deep brain stimulation in hemidystonia and hemichoreoathetosis following ischemic thalamic stroke

Deep brain stimulation (DBS) in secondary hyperkinetic movement disorders is challenging. Recently-introduced multi-target DBS may improve the outcome in these entities. We report a case of a 39-year old female with severe hemidystonia-choreoathetosis following an ischemic stroke of the right thalamus at the age of 25 years. The patient underwent combined unilateral electrode implantation of the subthalamic nucleus (STN) and the internal globus pallidus (GPi) for DBS. Activation of either one of the STN or GPi electrodes led to an overt clinical improvement. Combined simultaneous stimulation of both STN and GPi was even more effective. Multi-target DBS may be considered as a treatment option not only in idiopathic, but also symptomatic hyperkinetic movement disorders, even when performed years after the initiating event.