“Two Odd Targets” Strategy in Deep Brain Stimulation for Parkinson's Disease With Unilateral Levodopa Induced Dystonia

A 49-year-old man with Parkinson's disease developed the wearing-off and levodopa-induced dyskinesia with a dystonic component in the left upper limb. He decided to undergo deep brain stimulation. Asymmetric targets were chosen. For right side, globus pallidus interna was selected to improve the dystonia in his left upper extremity, and for left side, the subthalamic nucleus, which had the expected benefit of reducing the patient's medications, was selected. After the surgery, the levodopa-induced dystonia in his left arm was markedly improved, and the levodopa equivalent dose was reduced by 21.4%. Our case suggests that deep brain stimulation with a different target in the left and right hemisphere may be an effective therapeutic option for patients with asymmetric symptoms. This article is protected by copyright. All rights reserved.