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Pseudobulbar crying induced by stimulation in the region of the subthalamic nucleus
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  1. M S Okun1,2,
  2. D V Raju3,
  3. B L Walter3,
  4. J L Juncos3,
  5. M R DeLong3,
  6. K Heilman3,
  7. W M McDonald3,
  8. J L Vitek3
  1. 1Department of Neurology, University of Florida McKnight Brain Institute, Gainesville, FL, USA
  2. 2Departments of Neurosurgery and Psychiatry, University of Florida McKnight Brain Institute, Gainesville, FL, USA
  3. 3Department of Neurology, Emory University, Atlanta, GA, USA
  1. Correspondence to:
 M S Okun, MD
 University of Florida Movement Disorders Center, McKnight Brain Institute, PO BOX 100236, Gainesville, FL 32610 TUSA; okunneurology.ufl.edu

Abstract

We describe a case of pseudobulbar crying associated with deep brain stimulation (DBS) in the region of the subthalamic nucleus (STN). Patients with pseudobulbar crying show no other evidence of subjective feelings of depression such as dysphoria, anhedonia, or vegetative signs. This may be accompanied by other symptoms of pseudobulbar palsy and has been reported to occur with ischaemic or structural lesions in both cortical and subcortical regions of the brain. Although depression has been observed to result from DBS in the region of the STN, pseudobulbar crying has not been reported. A single patient who reported the symptoms of pseudobulbar crying after placement of an STN DBS was tested in the off DBS and on DBS conditions. The patient was tested using all four DBS lead contacts and the observations and results of the examiners were recorded. The Geriatric Depression Scale was used to evaluate for depression in all of the conditions. The patient exhibited pseudobulbar crying when on monopolar stimulation at all four lead contacts. The pseudobulbar crying resolved off stimulation. This case describes another type of affective change that may be associated with stimulation in the region of or within the STN. Clinicians should be aware of this potential complication, the importance of differentiating it from stimulation induced depression, and its response to a serotonin reuptake inhibitor, such as sertraline.

  • pseudobulbar crying
  • deep brain stimulation
  • mood
  • SSRI
  • STN
  • DBS, deep brain stimulation
  • MFB, medial forebrain bundle
  • SNr, substantia nigra pars reticulata
  • SSRI, selective serotonin reuptake inhibitor
  • STN, subthalamic nucleus
  • ZI, zona incerta

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Footnotes

  • Competing interests: none declared

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