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Panic and fear induced by deep brain stimulation
  1. N A Shapira1,
  2. M S Okun2,
  3. D Wint5,
  4. K D Foote3,
  5. J A Byars1,
  6. D Bowers4,
  7. U S Springer4,
  8. P J Lang4,
  9. B D Greenberg6,
  10. S N Haber7,
  11. W K Goodman1
  1. 1Department of Psychiatry, University of Florida, Gainesville, Florida, USA
  2. 2Departments of Neurology and Neurosurgery and Psychiatry, University of Florida, Gainesville
  3. 3Department of Neurosurgery, University of Florida, Gainesville
  4. 4Department of Clinical and Health Psychology, University of Florida, Gainesville
  5. 5Section on Integrative Neuroimaging, National Institute of Mental Health, Bethesda, Maryland, USA
  6. 6Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
  7. 7Department of Pharmacology and Physiology, University of Rochester, New York, USA
  1. 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}


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.

  • DBS, deep brain stimulation
  • DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th edition
  • OCD, obsessive-compulsive disorder
  • deep brain stimulation
  • fear
  • panic

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  • Competing interests: none declared