The Behavioral Complications of Pallidal Stimulation: A Case Report

We report a case of recurrent manic episodes associated with chronic deep brain stimulation (DBS) targeting globus pallidus (GP) in the treatment of Parkinson's disease (PD). Cardinal PD symptoms and dyskinesia improved with DBS, and neuropsychological testing found improvements in visuospatial...

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Bibliographic Details
Published in:Brain and cognition 2000-04, Vol.42 (3), p.417-434
Main Authors: Miyawaki, Edison, Perlmutter, Joel S., Tröster, Alexander I., Videen, Tom O., Koller, William C.
Format: Article
Language:English
Subjects:
Adult
Adult and adolescent clinical studies
Biological and medical sciences
Cerebrovascular Circulation - physiology
Cognition - physiology
deep brain stimulation
Electric Stimulation - methods
globus pallidus
Globus Pallidus - diagnostic imaging
Globus Pallidus - physiology
Humans
Key Words: mania
Male
Medical sciences
Neuropsychological Tests
Organic mental disorders. Neuropsychology
Parkinson Disease - physiopathology
Parkinson Disease - psychology
Parkinson Disease - therapy
Parkinson's disease
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Tomography, Emission-Computed
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Summary:We report a case of recurrent manic episodes associated with chronic deep brain stimulation (DBS) targeting globus pallidus (GP) in the treatment of Parkinson's disease (PD). Cardinal PD symptoms and dyskinesia improved with DBS, and neuropsychological testing found improvements in visuospatial measures associated with left DBS and in verbal memory with right DBS when compared to the patient's preoperative baseline. Under conditions of right, left, and bilateral DBS, the patient experienced bouts of mania and hypomania lasting several days at a time. Positron emission tomography (PET) with 15O-labeled water was performed after his first manic episode under four conditions: no stimulation, right DBS, left DBS, and bilateral DBS. Although no manic switch occurred during the course of the PET study, all three DBS conditions were associated with decreases in regional flow in the left parahippocampus and hippocampus and right mid-cingulate gyrus. Increases in flow in left inferior frontal area, bilateral insula, dorsolateral prefrontal cortex, and cuneus were common to all DBS conditions. GP stimulation in PD may be associated with behavioral and cognitive effects. Distributed blood flow changes observed with pallidal DBS support a role for the pallidum in cognition and affective regulation.
ISSN:0278-2626
1090-2147
DOI:10.1006/brcg.1999.1113