LAUSR

A‐67‐year‐old right‐handed male patient with akinetic rigid Parkinson’s disease (PD) had undergone subthalamic nucleus deep brain stimulation (STN–DBS) surgery [Figure 1, Table 1] due to severe freezing of gait (FOG) episodes, off periods, and dyskinesias, which could not be controlled by medical therapy. The STN–DBS surgery had provided substantial improvement in the motor symptoms including gait disturbance and FOG episodes. The levodopa equivalent daily dose was reduced by 50% after the surgery. However, soon after the operation, the patient could not initiate voluntary opening of the eyelids that was compatible with apraxia of eyelid opening (ALO). The initial DBS settings were as follow; bilateral most‐dorsal monopolar active contacts; 2.5 V (right), 3 V (left); 60 us (bilateral); 130 Hz (bilateral). The DBS adjustments including voltage increments and changing the localization of the bilateral active contacts did not yield any improvement in ALO, however it resulted in deterioration in motor symptoms. Besides, switching the DBS off also did not yield an improvement in ALO. Previously, in an experienced movement disorder center, bontulinum toxin (BoNT‐A) injections had been performed two times (at 3‐month intervals) into the pretarsal and lateral canthus region of the orbicularis oculi which had not provided a benefit. At this point, we also perform the electromyographic studies of the levator palpebrae superioris and the orbicularis oculi to understand the nature of the disturbance, however the patient did not accept the investigation. Interestingly, the patient had to use his left hand to open the lid and maintain the opening posture. However, he could not overcome ALO using his right hand and the assistance of another physician in the opening of the lid was also ineffective. The apraxia was mildly more apparent in the left eye. Of note, apraxia did not respond to levodopa therapy. The sensory tricks such as wearing goggles did not provide an amelioration. On final follow‐up, 6 years after DBS, the patient still suffers from ALO [Video 1].