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Panic and fear induced by deep brain stimulation

¹ Department of Psychiatry, University of Florida, Gainesville, Florida, USA
² Departments of Neurology and Neurosurgery and Psychiatry, University of Florida, Gainesville
³ Department of Neurosurgery, University of Florida, Gainesville
⁴ Department of Clinical and Health Psychology, University of Florida, Gainesville
⁵ Section on Integrative Neuroimaging, National Institute of Mental Health, Bethesda, Maryland, USA
⁶ Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
⁷ Department of Pharmacology and Physiology, University of Rochester, New York, USA

Correspondence to:
Correspondence to:
Dr Michael S Okun
University of Florida Brain Institute, Department of Neurology, 100 S Newell Drive, Room L3-100, Gainesville, FL 32610, USA; okun{at}neurology.ufl.edu

ABSTRACT
Background: Mood, cognitive, and behavioural changes have been reported with deep brain stimulation (DBS) in the thalamus, globus pallidus interna, and anterior limb of the internal capsule/nucleus accumbens region.

Objective: To investigate panic and fear resulting from DBS.

Methods: Intraoperative DBS in the region of the right and then left anterior limb of the internal capsule and nucleus accumbens region was undertaken to treat a 52 year old man with treatment refractory obsessive-compulsive disorder (OCD). Mood, anxiety, OCD, alertness, heart rate, and subjective feelings were recorded during intraoperative test stimulation and at follow up programming sessions.

Results: DBS at the distal (0) contact (cathode 0–, anode 2+, pulse width 210 ms, rate 135 Hz, at 6 volts) elicited a panic attack (only seen at the (0) contact). The patient felt flushed, hot, fearful, and described himself as having a "panic attack." His heart rate increased from 53 to 111. The effect (present with either device) was witnessed immediately after turning the device on, and abruptly ceased in the off condition

Conclusions: DBS of the anterior limb of the internal capsule and nucleus accumbens region caused severe "panic." This response may result from activation of limbic and autonomic networks.

Keywords: deep brain stimulation; fear; panic

This article has been cited by other articles:

				M. S Okun, H. H Fernandez, K. D Foote, T. K Murphy, and W. K Goodman Avoiding deep brain stimulation failures in Tourette syndrome J. Neurol. Neurosurg. Psychiatry, February 1, 2008; 79(2): 111 - 112. [Full Text] [PDF]

				M. S Okun, G. Mann, K. D Foote, N. A Shapira, D. Bowers, U. Springer, W. Knight, P. Martin, and W. K Goodman Deep brain stimulation in the internal capsule and nucleus accumbens region: responses observed during active and sham programming J. Neurol. Neurosurg. Psychiatry, March 1, 2007; 78(3): 310 - 314. [Abstract] [Full Text] [PDF]