"Off" state in Parkinson disease helped by bilateral subthalamic nucleus stimulation

This man with advanced Parkinson disease exhibits typical signs of Parkinson disease, including rigidity (not shown), bradykinesia, poverty of associated movements, difficulty rising, turning en bloc, and walking, requiring assistance during true "off" periods (at least 12 hours after last dose of levodopa). He improved markedly with bilateral subthalamic nucleus stimulation but did not regain the right armswing. (Contributed by Dr. Joseph Jankovic.)