gms | German Medical Science

Objective: Respiratory irregularities as a consequence of dopaminergic therapy for Parkinson’s disease has been described rarely and may be underrecognized in clinical practice. A case of transient respiratory disturbance after subthalamic nucleus deep brain stimulation for Parkinson disease previously treated with apomorphine is reported. Potential mechanisms whereby dopaminergic therapy and chronic electrical stimulation might influence the central control of respiration to produce irregular breathing patterns are discussed.

Methods: A 46-year-old man was treated with continuous subcutaneous apomorphine infusion over a six year period before the operation. After discontinuation of the apomorphine medication on the first postoperative day the patient presented with hiccup like abnormal breathing patterns unaffected by electrical stimulation or pharmacological management. Magnetic resonance imaging revealed correct positioning of the electrodes without structural abnormalities.

Results: Minutes after reinstitution of apomorphine medication the breathing abnormalities resolved. The apomorphine dose was gradually reduced and finally stopped after three days, whereas the patient remained free of hiccups. We never encountered abnormal breathing patterns in subthalamic nucleus deep brain stimulation or as a symptom of apomorphine withdrawal, nor find any reports in the literature.

Conclusions: To the knowledge of the authors this is the first report on abnormal breathing patterns after subthalamic nucleus deep brain stimulation. In the absence of possible explanations we hypothesise that the subthalamic nucleus or an adjacent structure may be involved in a supramedullary system controlling respiration.