OFF-Rebound Dyskinesia in Subthalamic Nucleus Stimulation in Parkinson Disease
Bibliographic record
Abstract
OFF-off rebound dyskinesia" in subthalamic nucleus (STN) deep brain stimulation (DBS) is a rare form of dyskinesia that occurs immediately after turning off the stimulation in the medication "off' state.The underlying mechanism is not known, but Brodsky et al 1 suggested it is a rebound phenomenon of the antidyskinesia induced by the stimulation of the fiber tracts adjacent to the STN since the active contacts were placed on the dorsal fiber tracts in their case.We report a case of "OFF-rebound dyskinesia" in a patient taking no levodopa when the active contact was placed exactly inside the STN and discuss the possible mechanism of this rare dyskinesia. CASE REPORTA 59-year-old woman developed rigidity on the left side of her body and bradykinesia at the age of 47.She was diagnosed with Parkinson's disease (PD) and started levodopa treatment, which produced an excellent response.After seven years of treatment, she developed severe motor fluctuations and two types of dyskinesia, peak-dose and diphasic (Video segment 1 on-line).Her pre-operative medications consisted of 1140 mg and 800 mg daily of levodopa/carbidopa and entacapone, respectively.At the age of 56, she received bilateral STN DBS surgery as previously described.2 Postoperatively, she experienced almost no "off' time but had stimulation-induced dyskinesias, which was worse on her left side following the initial stimulation.She took 200 mg daily of amantadine as the only antiparkinsonian medication because levodopa and dopamine agonists worsen dyskinesia.Her motor Unified Parkinson's Disease Rating Scale (UPDRS) score improved from 65 in the preoperative "off' state to 42 in the DBS-"ON"/medication-"o#" state at three months after the surgery (Table 1).At around five months after the surgery, an attempt was made to try to adjust the DBS parameters to improve the parkinsonism further (Table 2).The changed parameters resulted in the stimulation-induced dyskinesia becoming worse on both sides; therefore, the stimulator was turned off to reset it during the overnight 12-hour medication-ojff state.However, immediately after turning off the DBS, her dyskinesia was more accentuated, especially on her left side and this aggravation disappeared when the DBS was turned on again.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".