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Behind the Screen: Pseudobulbar Symptoms After Deep Brain Stimulation

  • Florian AmtageEmail author
  • Johann Lambeck
  • Sebastian Rutsch
  • Thomas Prokop
  • Marcus Pinsker
  • Michel Rijntjes
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 117)

Abstract

Background: Thalamotomy was formerly used to treat different tremor syndromes. Nowadays, deep brain stimulation has become an established technique to treat ­different movement disorders. The combination of these two stereotactic interventions is rare. Clinical Presentation: We present a patient in which a right-sided tremor ­syndrome with an underlying pathology of combined essential tremor and Parkinsonian tremor was successfully treated initially with a left-sided thalamotomy and subsequently with ­bilateral deep brain stimulation in the subthalamic nucleus. Results: Deep brain stimulation in the subthalamic nucleus resulted in hemidystonia, pathological laughing and crying, dysarthria and dysphagia, all due to dislocation of the stimulation electrodes contacting the internal capsule. After discontinuation of the high-frequency stimulation these side-effects disappeared, but were then reactivated by an LCD television in stand-by mode. Conclusion: In this report we discuss the pathophysiology of pseudobulbar symptoms and pathological laughing and crying in context of thalamotomy and dislocated DBS electrodes. Furthermore, we report on the occurrence that magnetic fields in the household have an impact on deep brain stimulation, even if they are in stand-by mode.

Keywords

Deep brain stimulation Thalamotomy Subthalamic nucleus Pathological laughing and crying Pseudobulbar Parkinson’s disease Television 

Notes

Acknowledgment

Many thanks for helpful comments on the manuscript to Dr. Sandra Dieni.

Conflict of InterestWe declare that we have no conflict of interest.

References

  1. 1.
    Boecker H, Wills AJ, Ceballos-Baumann A, Samuel M, Thomas DG, Marsden CD, Brooks DJ (1997) Stereotactic thalamotomy in tremor-dominant Parkinson’s disease: an H2(15)O PET motor activation study. Ann Neurol 41:108–111PubMedCrossRefGoogle Scholar
  2. 2.
    Deiber MP, Pollak P, Passingham R, Landais P, Gervason C, Cinotti L, Friston K, Frackowiak R, Mauguiere F, Benabid AL (1993) Thalamic stimulation and suppression of parkinsonian tremor. Evidence of a cerebellar deactivation using positron emission tomography. Brain 116:267–279PubMedCrossRefGoogle Scholar
  3. 3.
    Hellwig B, Häussler S, Lauk M, Guschlbauer B, Köster B, Kristeva-Feige R, Timmer J, Lücking CH (2000) Tremor-correlated cortical activity detected by electroencephalography. Clin Neurophysiol 111:806–809PubMedCrossRefGoogle Scholar
  4. 4.
    Hellwig B, Häussler S, Schelter B, Lauk M, Guschlbauer B, Timmer J, Lücking CH (2001) Tremor-correlated cortical activity in ­essential tremor. Lancet 357:519–523PubMedCrossRefGoogle Scholar
  5. 5.
    Henselmans JM, de Jong BM, Pruim J, Staal MJ, Rutgers AW, Haaxma R (2000) Acute effects of thalamotomy and pallidotomy on regional cerebral metabolism, evaluated by PET. Clin Neurol Neurosurg 102:84–90PubMedCrossRefGoogle Scholar
  6. 6.
    Low HL, Sayer FT, Honey CR (2008) Pathological crying caused by high-frequency stimulation in the region of the caudal internal capsule. Arch Neurol 65:264–266PubMedCrossRefGoogle Scholar
  7. 7.
    Okun MS, Raju DV, Walter BL, Juncos JL, DeLong MR, Heilman K, McDonald WM, Vitek JL (2004) Pseudobulbar crying induced by stimulation in the region of the subthalamic nucleus. J Neurol Neurosurg Psychiatry 75:921–923PubMedCrossRefGoogle Scholar
  8. 8.
    Parvizi J, Anderson SW, Martin CO, Damasio H, Damasio AR (2001) Pathological laughter and crying: a link to the cerebellum. Brain 124:1708–1719PubMedCrossRefGoogle Scholar
  9. 9.
    Parvizi J, Coburn KL, Shillcutt SD, Coffey CE, Lauterbach EC, Mendez MF (2009) Neuroanatomy of pathological laughing and crying: a report of the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci 21:75–87PubMedCrossRefGoogle Scholar
  10. 10.
    Wojtecki L, Nickel J, Timmermann L, Maarouf M, Sudmeyer M, Schneider F, Seitz RJ, Voges J, Sturm V, Schnitzler A (2007) Pathological crying induced by deep brain stimulation. Mov Disord 22:1314–1316PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Florian Amtage
    • 1
    Email author
  • Johann Lambeck
    • 1
  • Sebastian Rutsch
    • 1
  • Thomas Prokop
    • 2
  • Marcus Pinsker
    • 3
    • 4
  • Michel Rijntjes
    • 1
  1. 1.Department of NeurologyUniversity Medical Center FreiburgFreiburgGermany
  2. 2.Division of Stereotactic and Functional NeurosurgeryUniversity Medical Center FreiburgFreiburgGermany
  3. 3.Department of General Neurosurgery, Neurosurgical ClinicUniversity Medical Center FreiburgFreiburgGermany
  4. 4.Klinik für NeurochirurgieHELIOS Klinikum Berlin-BuchBerlinGermany

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