DEEP BRAIN STIMULATION IN LONG-STANDING PARKINSON DISEASE: A CLINICAL CASE WITH MULTIMODAL ASSESSMENT OF TREATMENT OUTCOMES
Keywords:
Parkinson disease, deep brain stimulation, DBS, subthalamic nucleus, neuromodulation, bradykinesia, tremor, motor fluctuations, neurorehabilitationAbstract
Background. Deep brain stimulation (DBS) is one of the most effective neuromodulatory treatments for advanced Parkinson disease, particularly in patients with disabling motor fluctuations, levodopa-induced dyskinesia, medication-refractory tremor, and impaired quality of life despite optimized dopaminergic therapy. We report a clinical case of a male patient born in 1972 with a disease duration exceeding 20 years and a documented diagnosis of stage 4 Parkinson disease with a rigid-tremor phenotype. The clinical presentation was dominated by tremor, bradykinesia, recurrent muscular rigidity, subjective weakness of the upper and lower extremities, and autonomic dysfunction manifested by constipation. Before surgery, the patient received combination antiparkinsonian therapy, and video recordings were available in medication-related ON and OFF conditions.
Case report. Following comprehensive preoperative neurological, neuropsychological, and neuroimaging assessment, a DBS system was implanted. To objectively characterize treatment response, a structured longitudinal assessment protocol is proposed, including MDS-UPDRS, Hoehn and Yahr staging, Schwab and England Activities of Daily Living Scale, PDQ-39, MoCA, Berg Balance Scale, Timed Up and Go, and calculation of levodopa equivalent daily dose. Particular emphasis is placed on comparative analysis of pre- and postoperative MRI and multislice CT, verification of lead trajectory and final contact position, exclusion of hemorrhagic complications, and correlation of imaging findings with clinical response.
Conclusion. This case demonstrates the value of a multimodal DBS strategy integrating stereotactic planning, postoperative imaging, individualized programming, pharmacological optimization, and structured neurorehabilitation.
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