TY - JOUR
T1 - The behavioral complications of pallidal stimulation
T2 - A case report
AU - Miyawaki, Edison
AU - Perlmutter, Joel S.
AU - Tröster, Alexander I.
AU - Videen, Tom O.
AU - Koller, William C.
N1 - Funding Information:
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 This study was supported by Medtronic, Inc., Minneapolis, MN, National Institutes of Health Grants NS32318, NS310001, NS32979, NS06833, and HL13851, and by the Greater St. Louis chapter of the American Parkinson’s Disease Association, the Clinical Hypotheses section of the Charles A. Dana Foundation, and the McDonnell Center for the Study of Higher Brain Function. The authors thank Diane Smith and Ms. Julie Fields of the University of Kansas Medical Center and Lori McGee-Minnich of Washington University for their assistance. MR images and help with the postoperative radiographic localization of the DBS leads were kindly provided by Louis Wetzel, M.D., of the University of Kansas Medical Center.
PY - 2000/4
Y1 - 2000/4
N2 - 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. (C) 2000 Academic Press.
AB - 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. (C) 2000 Academic Press.
KW - Deep brain stimulation
KW - Globus pallidus
KW - Mania
KW - Parkinson's disease
UR - http://www.scopus.com/inward/record.url?scp=0034076860&partnerID=8YFLogxK
U2 - 10.1006/brcg.1999.1113
DO - 10.1006/brcg.1999.1113
M3 - Article
C2 - 10753488
AN - SCOPUS:0034076860
SN - 0278-2626
VL - 42
SP - 417
EP - 434
JO - Brain and Cognition
JF - Brain and Cognition
IS - 3
ER -