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Fixed epiglottis associated with subthalamic nucleus stimulation in Parkinson’s disease
  1. M Yanase1,
  2. H Kataoka1,
  3. M Kawahara1,
  4. H Hirabayashi2,
  5. T Yamanaka3,
  6. M Hirano1,
  7. S Ueno1
  1. 1
    Department of Neurology, Nara Medical University, Kashihara, Nara, Japan
  2. 2
    Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
  3. 3
    Department of Otorhinolaryngology, Nara Medical University, Kashihara, Nara, Japan
  1. Dr Kataoka, Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; hk55{at}naramed-u.ac.jp

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Deep brain stimulation (DBS) of the subthalamic nucleus (STN) alleviates motor disability of patients with Parkinson’s disease (PD). Mental changes and other adverse events are common, but typically transient. Severe complications such as intracerebral haemorrhage or infection are rare,1 but 6 of 73 patients who underwent STN-DBS died of pneumonia, cardiac failure or pulmonary embolism.1 We describe a patient with PD who had sudden respiratory difficulty due to a fixed epiglottis after STN-DBS. This symptom was confirmed to be related to STN stimulation on fibre-optic examination of the larynx.

CASE REPORT

In December 1995, a 76-year-old man noticed slowness of movements. He had moderate parkinsonism, associated with masked face, stooped posture, bradykinesia, right-side-dominant rigidity and resting tremor. Bradykinesia and rigidity responded to treatment with levodopa. In August 2006, he became severely disabled due to “on–off” phenomena and hallucinations while receiving levodopa, cabergoline, pergolide, quetiapine and risperidone. In September, the patient underwent STN-DBS. Because the right stimulator was located slightly medially to the STN, he underwent a second operation to adjust its position in October (fig 1). Motor disability and hallucinations then decreased at the following STN-DBS settings: cathodic bipolar stimulation, 90 μsec pulse width, 1.7 V and …

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