References 1. Durr A, Brice A. Clinical and genetics aspects of spinocerebellar degeneration. Curr Opin Neurol 2000;13:407– 413. 2. Campuzano V, Montermini L, Molto MD, Pianese L, Cossee M, Cavalcanti F, et al. Friedreich’s ataxia: autosomal recessive disease caused by an intronic GAA triplet repeat expansion. Science 1996; 271:1423–1427. 3. Harding AE. Friedreich’s ataxia: a clinical and genetic study of 90 families with an analysis of early diagnostic criteria and intrafamil- ial clustering of clinical features. Brain 1981;104:589 – 620. 4. Garcia Ruiz PJ, Mayo D, Hernandez J, Cantarero S, Ayuso C. Movement disorders in hereditary ataxias. J Neurol Sci 2002;202: 59 – 64. 5. Hou JG, Jankovic J. Movement disorders in Friedreich’s ataxia. J Neurol Sci 2003;206:59 – 64. 6. Ragno M, De Michele G, Cavalcanti F, et al. Broadened Friedreich’s ataxia phenotype after gene cloning. Minimal GAA expansion causes late-onset spastic ataxia. Neurology 1997;49:1617–1620. 7. Lance JW. Symposium synopsis. In: Feldman RG, Young RR, Koella WP, editors. Spasticity: disorder of motor control. Chicago: Year Book Medical Publishers; 1980. p 485– 494. 8. Lundberg A. Multisensory control of spinal reflex pathways. Prog Brain Res 1979;50:11–28. Hemiparkinsonism and Levodopa-Induced Dyskinesias After Focal Nigral Lesion Evz ˇen Ru ˚z ˇic ˇka, MD, DSc, 1 * Dus ˇan Urgos ˇı ´k, MD, PhD, 2 Robert Jech, MD, PhD, 1 Jan Roth, MD, PhD, 1 Josef Vymazal, MD, PhD, 2 Petr Mec ˇı ´rˇ,MD, 1 and Vilibald Vladyka, MD, PhD 2 1 Movement Disorders Center, 1st Medical Faculty, Charles University, Prague, Czech Republic 2 Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic Abstract: We present a patient with tremor-dominant hemipar- kinsonism after a focal lesion to the substantia nigra. An excellent response to levodopa was complicated by rapid de- velopment of motor fluctuations and disabling dyskinesias. Stereotactic thalamotomy resulted in a persistent extinction of parkinsonism and of dyskinesias along with stopping dopami- nergic treatment. © 2005 Movement Disorder Society Key words: parkinsonism; levodopa-induced dyskinesias; substantia nigra lesion; thalamotomy; motor fluctuations Levodopa (L-dopa)-induced dyskinesias (LID) are character- istic motor complications of Parkinson’s disease (PD) that have been related to dysregulation in the striatum caused by various factors such as denervation supersensitivity and pulsatile stim- ulation of postsynaptic dopamine receptors. 1 In various animal models of parkinsonism, motor fluctuations and LID were produced by L-dopa depending on the degree of nigral le- sion. 2–4 It remains unclear, however, whether LID and motor fluctuations may occur in a patient with parkinsonism due to a lesion of the substantia nigra. We present a case of dopa- responding hemiparkinsonism after focal nigral lesion that was complicated by wearing-off effect of L-dopa and by LID. Case Report In April 1997, a 19-year-old previously healthy young woman presented with acute headache and diplopia, which led to the diagnosis of a noncommunicating hydrocephalus induced by a colloidal cyst in the third ventricle. In June 1997, a stereoendoscopic neurosurgical procedure aimed at evacuating the cyst was complicated by a hemorrhage into the third ven- tricle and upper brainstem resulting in right-sided hemiparesis and hemihypesthesia. Although the hemiparesis regressed, This article includes Supplementary Video, available online at http:// interscience.wiley.com/jpages/0885-3185/suppmat. *Correspondence to: Prof. Evz ˇen Ru ˚z ˇic ˇka, Movement Disorders Center,Katerˇinska ´ 30, CZ-120 00 Praha, Czech Republic. E-mail: eruzi@lf1.cuni.cz Received 3 August 2004; Revised 27 October 2004; Accepted 31 October 2004 Published online 21 March 2005 in Wiley InterScience (www. interscience.wiley.com). DOI: 10.1002/mds.20453 FIG. 1. EMG Gastrocnemius activity after manual plantar sole stim- ulation before and after IT baclofen injection. Effect of the plantar foot brushing on the gastrocnemius EMG activity after intrathecal injection of 100 g of baclofen. Recordings were made before and 10, 20, 30, 40, 50, and 60 minutes after the injection. The foot brushing was applied for 2 seconds. CLINICAL/SCIENTIFIC NOTES 759 Movement Disorders, Vol. 20, No. 6, 2005