Objective: This is the first report of acute, stimulation‐locked, reversible psychiatric symptoms induced by GPi‐DBS in dystonia. We here demonstrate three cases where patients had stimulation induced negative mood changes, and explore the possible mechanisms for such phenomena.

Background: Deep brain stimulation (DBS) of subthalamic nucleus (STN), globus pallidus internus (GPi) and ventrointermedial nucleus (VIM) are well-established, safe, and effective treatments for Parkinson’s disease (PD), dystonia and tremor when medical treatments are suboptimal. Adverse behavioral effects have been well observed in STN-DBS in PD; however, these phenomena can occur with VIM- and GPi-DBS as well.

Methods: Case 1: A 62-year-old male underwent bilateral STN-DBS due to significant motor fluctuations and disabling dyskinesia. His motor complications improved post-DBS, however, he reported pseudobulbar affect (PBA) and cried easily during programming. Case 2: A 49-year-old female underwent bilateral GPi-DBS for cervical dystonia after failed botulinum toxin. During threshold testing, she reported sadness and started crying when contact 8 (right) was stimulated. This acute sadness subsided quickly after stimulation was removed from contact 8. Case 3: A 57-year-old male with a long history of refractory essential tremor had staged right VIM-DBS, followed by left lead implant 9 months later. Intro-operatively, he had feelings of “sadness” and cried with macroelectrode stimulation. During optimizing programming, he had labile mood/PBA, which improved with bipolar settings.

Results: Mood effects with STN-DBS have been widely reported in PD, secondary to changes of anti-PD medications and STN-DBS effects on limbic circuit. For GPi-DBS in dystonia, acute mood change in people without neuropsychiatric comorbidities have not been reported. GPi-DBS may have interfered either with limbic pathways to which ventromedial GPi is connected, or with adjacent limbic structures due to the spread of current. VIM-induced adverse behavioral effects are uncommon. However, stimulation-induced PBA can be related to current spreading from VIM to cortico-bulbar tract and cortico-ponto-cerebellar fibers.

Conclusions: Adverse behavioral effects can occur in STN-DBS, and less commonly with GPi-DBS and VIM-DBS. It is important to be vigilant following DBS implantation and programming. Detailed history and careful programming are crucial.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/emotional-lability-following-deep-brain-stimulation-targeting-subthalamic-nucleus-globus-pallidus-internus-and-ventrointermedial-nucleus-of-thalamus/