Objective:

NA

Background:

Post-anoxic chorea is a rare yet severe movement disorder that can arise following hypoxic-ischemic brain injury. We report the case of a young man who developed severe post-anoxic chorea after cardiac arrest from an opiate overdose. Despite aggressive pharmacological management, the patient experienced significant disability due to persistent, debilitating choreiform movements and was approaching the need for end-of-life care. Neuroimaging revealed severe bilateral globus pallidus damage.

Design/Methods:

Given the severity of symptoms, deep brain stimulation (DBS) was selected as the intervention of choice. Because both globus pallidi showed significant damage, a novel approach was employed in which eight-contact standard DBS leads (Boston Scientific DB2201), with a contact span of 15.5 mm, were implanted bilaterally. The leads were strategically positioned, with the deeper contacts targeting the subthalamic nucleus (STN) and the dorsal contacts targeting the ventral anterior (VA) thalamic nucleus. According to Hassler's thalamic nomenclature, the VA nucleus serves as the primary thalamic relay for pallidal afferents, making it an ideal target for this dual-stimulation approach. STN stimulation was programmed at 10 Hz, 60 μs, 1 mA, while VA stimulation was set at 185 Hz, 90 μs, 1 mA.

Results:

Within a few days, the patient showed marked improvement in both the frequency and intensity of chorea, alongside a significant restoration of functional independence.

Conclusions:

This case highlights the potential utility of DBS as a therapeutic option for patients with severe, refractory post-anoxic chorea, particularly when conventional approaches are limited. By simultaneously stimulating two distinct brain regions at different frequencies, a strategy enabled by our mechanistic understanding of DBS and the availability of advanced technology such as longer leads and a Multiple Independent Current Control system, we were able to achieve substantial clinical improvement in an otherwise highly challenging scenario.