1. Hyperhidrosis associated with subthalamic deep brain stimulation in Parkinson's disease: Insights into central autonomic functional anatomy.
- Author
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Ramirez-Zamora A, Smith H, Youn Y, Durphy J, Shin DS, and Pilitsis JG
- Subjects
- Adult, Autonomic Nervous System diagnostic imaging, Autonomic Nervous System physiopathology, Deep Brain Stimulation methods, Female, Functional Laterality, Humans, Hyperhidrosis pathology, Hyperhidrosis physiopathology, Male, Middle Aged, Parkinson Disease diagnostic imaging, Parkinson Disease physiopathology, Retrospective Studies, Deep Brain Stimulation adverse effects, Hyperhidrosis etiology, Parkinson Disease therapy, Subthalamic Nucleus diagnostic imaging, Subthalamic Nucleus physiopathology
- Abstract
Introduction: There is limited evidence regarding the precise location and connections of thermoregulatory centers in humans. We present two patients managed with subthalamic nucleus (STN) Deep Brain Stimulation (DBS) for motor fluctuations in PD that developed reproducible hyperhidrosis with high frequency DBS., Objective: To describe the clinical features and analyze the location of the electrodes leading to autonomic activation in both patients., Methods: We retrospectively assessed the anatomical localization, electrode programming settings and effects of unilateral STN DBS leading to hyperhidrosis., Results: Unilateral stimulation of anterior and medially located contacts within the STN and zona incerta (Zi) caused bilateral, consistent, reproducible, and reversible sweating in our patients. Adequate control of motor symptoms without autonomic side effects was accomplished with alternative programming settings., Conclusion: Stimulation of the medial Zi and medial and anterior STN causes hyperhidrosis in a pattern similar to that described in primates and rats. We speculate that central autonomic fibers originating in the lateral hypothalamic area project laterally to the ventral/medial Zi and then to brainstem nuclei following an medial and posterior trajectory in relationship to STN., (Copyright © 2016 Elsevier B.V. All rights reserved.)
- Published
- 2016
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