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Intractable facial pain in advanced Parkinson’s disease alleviated by subthalamic nucleus stimulation
  1. K Samura1,
  2. Y Miyagi,
  3. T Morioka1,
  4. N Murakami3,
  5. F Yoshida1,
  6. K Hashiguchi1,
  7. N Sakae4,
  8. R Yamasaki4,
  9. M Kawaguchi5,
  10. S Nagata1,
  11. T Sasaki1
  1. 1
    Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  2. 2
    Division of Digital Patient, Digital Medicine Initiative, Kyushu University, Fukuoka, Japan
  3. 3
    Department of Neurosurgery, Kaizuka Hospital, Fukuoka, Japan
  4. 4
    Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  5. 5
    Department of Rehabilitation, Kyushu University Hospital, Fukuoka, Japan
  1. Dr Y Miyagi, Division of Digital Patient, Digital Medicine Initiative, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812–8582 Japan; yamiyagi{at}digital.med.kyushu-u.ac.jp

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Pain may occur in about half of patients with Parkinson’s disease (PD).13 We describe a rare case who had intractable facial pain with allodynia as a result of long term levodopa replacement therapy, which was alleviated by subthalamic nucleus-deep brain stimulation (STN-DBS).

CASE REPORT

A 55-year-old woman developed claudication in the right leg at the age of 37 years. One year later, she developed tremor in the right leg and clumsiness of the right hand, and she began to take levodopa. During the following 17 years, her parkinsonism gradually advanced, irrespective of medical control with pergolide, pramipexole and selegiline, as well as levodopa. Until 3 months prior to surgery, the levodopa dosage was progressively increased up to 1150 mg per day because of a wearing off phenomenon. She felt some diffuse numbness in the whole face, symmetrically, from 6 months prior to the surgery, which gradually turned into a piercing or tingling pain from 2 months prior to the surgery. On admission to our hospital, her facial pain was so severe that she could neither touch her face nor open her eyelids. In the “off” state, she could not even move from her bed because of her severe facial pain …

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