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Abstract Details

Pallidal Deep Brain Stimulation Induced Keyboard Typing Dysfunction
Movement Disorders
Movement Disorders Posters (7:00 AM-5:00 PM)
105
NA
Typing on a keyboard requires complex coordination and collaboration between visuospatial/procedural memory, language and motor function. The impaired ability to type, independent of motor deficits, apraxia or aphasia has been coined “dystypia”.  Dystypia can be disruptive and impact activities of daily living given the heavy modern use of technology. In light of recent reports of swimming dysfunction following deep brain stimulation (DBS), we report a case of dystypia (keyboard typing dysfunction) as a potential side effect of DBS therapy.

A 68-year-old woman with a history of blepharospasm, oromandibular and segmental dystonia underwent bilateral globus pallidus internus (GPi) DBS because of a waning response to botulinum toxin therapy. Following DBS, she discovered she no longer “remembered” how to type fluidly and had to “hunt and peck” for letters on the keyboard. This issue persisted at two-year follow-up.

The patient underwent serial typing tests with the DBS ON versus OFF. Post-operative lead reconstruction was performed using Lead-DBS. Volume of tissue activation modeling was combined with whole brain tractography.

Typing improved when the device was switched to the DBS OFF state. Structural connectivity analysis revealed strong modulation of the right angular gyrus, left calcarine fissure and left cuneus. There was also activation of bilateral supplemental motor areas and superior parietal gyri.

Shared lesion topography analysis of dystypia cases in the literature has suggested involvement of the superior longitudinal fasciculus (SLF). The SLF involves the superior parietal lobe, angular gyrus, supramarginal gyrus, and arcuate fasiculus. Our patient’s connectivity pattern suggested SLF involvement. The improvement in OFF state typing and her imaging together suggested that the dystypia in her case was a stimulation-induced side effect.
Dystypia is a rare side effect of DBS therapy and may be associated with SLF involvement.
Authors/Disclosures
Joshua Wong, MD (University of Florida College of Medicine - Neurology)
PRESENTER 		The institution of Dr. Wong has received research support from NIH.
Melissa Armstrong, MD, MSc, FÂ鶹´«Ã½Ó³»­ (UF Department of Neurology) The institution of Dr. Armstrong has received research support from National Institutes of Health. The institution of Dr. Armstrong has received research support from Florida Department of Health. The institution of Dr. Armstrong has received research support from Lewy Body Dementia Association. The institution of Dr. Armstrong has received research support from The Michael J. Fox Foundation. Dr. Armstrong has received personal compensation in the range of $5,000-$9,999 for serving as a DSMB member with Alzheimer's Clinical Trials Consortium. Dr. Armstrong has received personal compensation in the range of $5,000-$9,999 for serving as a DSMB member with Alzheimer's Disease Cooperative Study. Dr. Armstrong has received personal compensation in the range of $500-$4,999 for serving as a DSMB member with National Institutes of Health. Dr. Armstrong has a non-compensated relationship as a Member, Scientific Advisory Council with Lewy Body Dementia Association that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
Leonardo Almeida (University of Florida College of Medicine - Neurology) No disclosure on file
Aparna Wagle-Shukla, MD, FÂ鶹´«Ã½Ó³»­ (UF Fixel) Dr. Wagle-Shukla has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Encora. Dr. Wagle-Shukla has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Supernus. Dr. Wagle-Shukla has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Tremor research group. The institution of Dr. Wagle-Shukla has received research support from NIH. Dr. Wagle-Shukla has received personal compensation in the range of $500-$4,999 for serving as a reviewer with NIH.
Addie Patterson, DO (University of Florida Fixel Institute) Dr. Patterson has received personal compensation in the range of $500-$4,999 for serving as a Content creator with Medical insights group.
Michael S. Okun, MD, FÂ鶹´«Ã½Ó³»­ (University of Florida) Dr. Okun has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Okun has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Parkinson's Foundation. Dr. Okun has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Okun has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch. The institution of Dr. Okun has received research support from NIH. The institution of Dr. Okun has received research support from Parkinson's Foundation. The institution of Dr. Okun has received research support from Tourette Association of America. The institution of Dr. Okun has received research support from Michael J Fox. Dr. Okun has received publishing royalties from a publication relating to health care.
Irene Malaty, MD, FÂ鶹´«Ã½Ó³»­ (University of Florida) Dr. Malaty has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie. Dr. Malaty has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Aevum. The institution of Dr. Malaty has received research support from Abbvie. The institution of Dr. Malaty has received research support from Revance. The institution of Dr. Malaty has received research support from Parkinson Foundation. The institution of Dr. Malaty has received research support from SAGE. The institution of Dr. Malaty has received research support from Emalex. The institution of Dr. Malaty has received research support from Acadia. Dr. Malaty has received publishing royalties from a publication relating to health care. Dr. Malaty has received personal compensation in the range of $500-$4,999 for serving as a Speaker & Center of Excellence Director with Parkinson Foundation. Dr. Malaty has a non-compensated relationship as a MAB member & Center of Excellence Directory with Tourette Association of America that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.