Interestingly, the patient became anxious but did not cry when monopolar stimulation at a frequency of 50 Hz via contact 6 or 7 (0.5 V, 60 microseconds) was applied. Stimulation through other contacts did not elicit a similar response. The Beck Depression Inventory score before and during monopolar stimulation of contact 6 was 10 (0-10 being normal, with scores > 10 indicative of increasing mood disturbance). Similar responses were observed with bipolar stimulation through contacts 6 (cathodal) and 7 (anodal) at amplitudes of 1.0 V or greater. Crying stopped within 5 seconds of stimulation cessation. There was no sensation of sadness, pain, or persecution. The patient did not know why she was crying and could not stop herself from crying. Sham testing did not elicit a similar response. This occurred even when parameter changes were visibly concealed from the patient. The patient began to cry uncontrollably within seconds of monopolar stimulation (0.5 V, 60 microseconds, 130 Hz) involving contact 6 (x, y, z = −11.5 mm, −3.8 mm, −12.2 mm, respectively). Stimulation titration began 6 weeks postoperatively with the patient not receiving medication for at least 12 hours. Electrode contacts were numbered 0 to 3 from deep to superficial on the right and 4 to 7 from deep to superficial on the left. The right STN electrode was implanted in a similar manner. The most distal contact was placed at t = +3. There was significant clinical improvement during macrostimulation. Approaching the left target (x, y, z = −13.7 mm, −1.3 mm, −6.1 mm, respectively), microelectrode recordings characteristic of the STN were encountered from 2 mm above the target ( t = −2) to 3 mm below it ( t = +3) and the substantia nigra from t = +4.5. The targets were selected from axial fast short time inversion recovery magnetic resonance images and adjusted intraoperatively following microelectrode recordings and macroelectrode stimulation. She underwent bilateral insertion of STN electrodes (Medtronic 3389 Medtronic, Inc, Minneapolis, Minnesota). Preoperative Unified Parkinson Disease Rating Scale motor subscale scores while receiving and not receiving medication were 52 and 13, respectively. Structured preoperative neuropsychiatric evaluation and brain imaging revealed no cognitive, mood, or psychiatric disturbances or structural lesions. This very localized effect argues for a distinct neural pathway for PC, separate from the larger constellation of symptoms that occur in PLC or the pseudobulbar syndrome.Ī 48-year-old, left-handed woman with a 9-year history of Parkinson disease presented with severe motor fluctuations and disabling dyskinesias despite receiving 1150 mg of levodopa, 1200 mg of entacapone, 5 mg of selegiline hydrochloride, and 6 mg of pramipexole dihydrochloride daily. We report a case where high-frequency stimulation via a single contact in the region of the caudal internal capsule (CIC) resulted only in PC. 6 In that article, PC, slurring of speech, and exaggeration of facial and gag reflexes were observed with monopolar stimulation through contacts extending from the subthalamus to the thalamus. Prior to this article, there has only been 1 other case of PC following deep brain stimulation (DBS) to our knowledge. 1, 2 Pathological laughing and crying are often included as part of a wider pseudobulbar syndrome that may include disturbances of swallowing, speech, bulbar function, and exaggeration of facial, palatal, and jaw reflexes.Īlthough PLC is frequently encountered in a variety of neurological disorders, reports of crying or laughing following stimulation of the thalamus, 3 globus pallidus interna, 3 subthalamic nucleus (STN), 4 and substantia nigra 5 are rare and have all been associated with an emotional component. 1 This condition may be accompanied by laughter (pathological laughter and crying ), which is assumed to share a common mechanism. Pathological crying (PC) is a disorder of emotional expression characterized by involuntary, recurrent bouts of crying that are incongruent with the prevailing emotional, cognitive, and social context and is not associated with a sensation of sadness. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |