Acta Neurochirurgica

, Volume 154, Issue 5, pp 835–838 | Cite as

Evidence of a non-motor microlesion effect following deep brain surgery: a case report

  • Verena Eveline Rozanski
  • Martin Lieb
  • Christian Vollmar
  • Jan-Hinnerk Mehrkens
  • Kai Bötzel
Case Report


We report the case of a patient who developed acute transient psychosis after implantation, but not activation of pallidal deep brain electrodes for generalised dystonia. Psychotic symptoms coincided temporally with postoperative motor improvement induced by the microlesion effect after electode implantation. This finding suggests that the microlesion effect may not be confined to motor improvement, but also comprises non-motor symptoms. In our case, affection of adjacent dopaminergic fibres of passages has to be assumed.


Deep brain stimulation Globus pallidus internus Microlesion effect Dopaminergic fibres 


  1. 1.
    Barkhoudarian G, Klochkov T, Sedrak M, Frew A, Gorgulho A, Behnke E, De Salles A (2010) A role of diffusion tensor imaging in movement disorder surgery. Acta Neurochir 152:2089–1095CrossRefGoogle Scholar
  2. 2.
    Baron MS, Noonan JB, Mewes K (2006) Restricted ablative lesions in motor portions of Gpi in primates produce extensive loss of motor-related neurons and degeneration of the lenticular fascisulus. Exp Neurol 202:67–705PubMedCrossRefGoogle Scholar
  3. 3.
    Bejjani BP, Damier P, Arnulf I, Thivard L, Bonnet AM, Dormont D, Cornu P, Pidoux B, Samson Y, Agid Y (1999) Transient acute depression induced by high-frequency deep-brain stimulation. N Engl J Med 340:1476–1480PubMedCrossRefGoogle Scholar
  4. 4.
    Cerosimo MG, Raina GB, Piedimonte F, Antico J, Graff P, Micheli FE (2008) Pallidal surgery for the treatment of primary generalized dystonia: Long-term follow-up. Clin Neurol Neurosurg 110:145–150CrossRefGoogle Scholar
  5. 5.
    Cerosimo MG, Raina BG, Benaroch EE, Piedimonte F, Aleman GG, Micheli FE (2009) Micro lesion effect of the globus pallidus internus and outcome with deep brain stimulation in patients with Parkinson’s disease and dystonia. Mov Disord 24:1488–1493CrossRefGoogle Scholar
  6. 6.
    Coenen VA, Honey CD, Hurwitz T, Rahman AA, McMaster J, Bürgel U (2009) Medial forebrain bundle stimulation as a pathophysiological mechanism for hypomania in subthalamic nucleus deep brain stimulation for Parkinson’s disease. Neurosurgery 64:1106–1115PubMedCrossRefGoogle Scholar
  7. 7.
    Coenen VA, Allert N, Mädler B (2011) A role of diffusion tensor imaging fibre tracking in deep brain stimulation surgery: DBS of the dentate-rubro-thalamic tract (DRT) for the treatment of therapy-refractory tremor. Acta Neurochir 153(8):1579–1585CrossRefGoogle Scholar
  8. 8.
    Granziera C, Pollo C, Russmann H, Staedler C, Ghika J, Villemure JG, Burkhard PR, Vingerhoets FJG (2008) Sub-acute delayed failure of subthalamic DBS in Parkinson’s disease: The role of micro lesion effect. Parkinsonism Related Disorders 14:109–113PubMedCrossRefGoogle Scholar
  9. 9.
    Haegelen C, Rouaud T, Darnault P, Marandi X (2009) The subthalamic nucleus is a key-structure of limbic basal ganglia functions. Med Hypotheses 72:421–426PubMedCrossRefGoogle Scholar
  10. 10.
    Heinz A, Schlagenhauf F (2010) Dopaminergic dysfunction in schizophrenia: salience attribution revisited. Schizophr Bull 36:472–485PubMedCrossRefGoogle Scholar
  11. 11.
    Kupsch A, Benecke R, Müller J, Trottenberg T, Schneider GH, Poese W, Eisner W, Wolters A, Müller JU, Deuschl G, Pinsker MO, Skogseid IM, Roeste GK, Vollmer-Hase J, Brentrup A, Krause M, Tronnier V, Schnitzler A, Voges J, Nikkah G, Vesper J (2006) Pallidal deep- brain stimulation in primary generalized or segmental dystonia. N Engl J Med 355:1978–1990PubMedCrossRefGoogle Scholar
  12. 12.
    Mehrkens JH, Borggraefe I, Feddersen B, Heinen F, Bötzel K (2010) Early gobus pallidus internus stimulation in paediatric patients with generalized primary dystonia: long-term efficacy and safety. J Child Neurol 25:1355–1358PubMedCrossRefGoogle Scholar
  13. 13.
    Oishi K (2011) MRI atlas of human white matter. Elsevier, AmsterdamGoogle Scholar
  14. 14.
    Shapira NA, Okun MS, Wint D, Foote KD, Byars JA, Bowers D, Springer US, Lang PJ, Greenberg BD, Haber SN, Goodman WK (2006) Panic and fear induced by deep brain stimulation. J Neurol Neurosurg Psychiatry 77:410–412PubMedCrossRefGoogle Scholar
  15. 15.
    Ulla M, Lemaire JJ, Schmitt A, Derost P, Brousolle E, Llorca PM, Durif F (2006) Manic behaviour induced by deep-brain stimulation in Parkinson’s disease: evidence of substantia nigra implication? J Neurol Neurosurg Psychiatry 77:1363–1366PubMedCrossRefGoogle Scholar
  16. 16.
    Winkler PA, Vollmar C, Krishnan KG, Pfluger T, Brückmann H, Noachtar S (2000) Usefulness of 3-D reconstructed images of the human cerebral cortex for localization of subdural electrodes in epilepsy surgery. Epilepsy Res 41(2):169–178PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Verena Eveline Rozanski
    • 1
  • Martin Lieb
    • 2
  • Christian Vollmar
    • 1
  • Jan-Hinnerk Mehrkens
    • 1
  • Kai Bötzel
    • 1
  1. 1.Department of Neurology, Klinikum GrosshadernUniversity of MunichMünchenGermany
  2. 2.Department of Psychiatry, Klinikum GrosshadernUniversity of MunichMunichGermany

Personalised recommendations