The behavioral complications of pallidal stimulation: A case report

Edison Miyawaki, Joel S. Perlmutter, Alexander I. Tröster, Tom O. Videen, William C. Koller

Research output: Contribution to journalArticlepeer-review

85 Scopus citations


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.

Original languageEnglish
Pages (from-to)417-434
Number of pages18
JournalBrain and Cognition
Issue number3
StatePublished - Apr 2000


  • Deep brain stimulation
  • Globus pallidus
  • Mania
  • Parkinson's disease


Dive into the research topics of 'The behavioral complications of pallidal stimulation: A case report'. Together they form a unique fingerprint.

Cite this