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Contact dependent reproducible hypomania induced by deep brain stimulation in Parkinson's disease: clinical, anatomical and functional imaging study
  1. Miguel Ulla1,2,
  2. Stéphane Thobois3,4,5,
  3. Pierre-Michel Llorca2,6,
  4. Philippe Derost1,2,
  5. Jean-Jacques Lemaire1,
  6. Isabelle Chereau-Boudet2,6,
  7. Ingrid de Chazeron2,
  8. Audrey Schmitt6,
  9. Bénédicte Ballanger3,4,5,
  10. Emmanuel Broussolle3,4,5,
  11. Franck Durif1,2
  1. 1CHU Clermont-Ferrand, Service de Neurologie A, Clermont-Ferrand, France
  2. 2Univ Clermont 1, EA3845, Clermont-Ferrand, France
  3. 3Université Lyon I, Faculté de médecine Lyon Sud Charles Mérieux, Lyon, France
  4. 4Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Lyon, France
  5. 5CNRS, Centre de Neurosciences Cognitives, UMR 52-29, Bron, France
  6. 6CHU Clermont-Ferrand, Service de Psychiatrie B, Clermont-Ferrand, France
  1. Correspondence to Dr M Ulla, Service de Neurologie A, Hôpital Gabriel Montpied, 58 rue Montalembert, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; mulla{at}


Hypomanic symptoms depending on anatomical location of contacts are reported in patients with Parkinson's disease (PD) treated by deep brain stimulation (DBS) of the subthalamic nucleus (STN). However, the underlying cortical and subcortical dysfunction is debated. In this study, five PD patients implanted with DBS–STN who presented with reversible and reproducible hypomanic symptoms after stimulation of specific ‘manic’ contacts were investigated. Hypomanic symptoms were assessed using the Bech and Rafaelsen Mania Scale (MAS). Three dimensional anatomical location of ‘euthymic’ and ‘manic’ contacts, after matching the postoperative CT scan with the preoperative stereotactic MRI, and a H215O positron emission tomography (PET) study testing ‘euthymic’ and ‘manic’ contacts, were performed. Under ‘euthymic’ conditions, MAS score (mean±SD) was 0.6±0.5 compared with 7.8±3.1 under ‘manic’ conditions. Nine of 10 ‘manic’ contacts were located in the substantia nigra, mainly in its ventral part. PET showed that hypomania was associated with strong asymmetrical cerebral activation involving preferentially the right hemisphere and was mediated by activation of the anterior cingulate and medial prefrontal cortex. The present study demonstrates the role of the subcortical structures in the genesis of hypomania in PD patients treated with DBS and stresses the involvement of the substantia nigra.

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  • Funding This research was supported by grant PHRC 2005 from the Programme Hospitalier de Recherche Clinique.

  • Competing interests None.

  • Ethics approval The study was conducted with the approval of the ethics committee of Clermont-Ferrand University Hospital (file AU 631).

  • Provenance and peer review Not commissioned; externally peer reviewed.