Turning on the Left Side Electrode Changed Depressive State to Manic State in a Parkinson's Disease Patient Who Received Bilateral Subthalamic Nucleus Deep Brain Stimulation: A Case Report

No previous reports have described a case in which deep brain stimulation elicited an acute mood swing from a depressive to manic state simply by switching one side of the bilateral deep brain stimulation electrode on and off. The patient was a 68-year-old woman with a 10-year history of Parkinson's disease. She underwent bilateral subthalamic deep brain stimulation surgery. After undergoing surgery, the patient exhibited hyperthymia. She was scheduled for admission. On the first day of admission, it was clear that resting tremors in the right limbs had relapsed and her hyperthymia had reverted to depression. It was discovered that the left-side electrode of the deep brain stimulation device was found to be accidentally turned off. As soon as the electrode was turned on, motor impairment improved and her mood switched from depression to mania. The authors speculate that the lateral balance of stimulation plays an important role in mood regulation. The current report provides an intriguing insight into possible mechanisms of mood swing in mood disorders.

Target localization of subthalamic nucleus based on the center of the red nucleus / 中华神经医学杂志

Objective To investigate an approach for locating the operation target of deep brain stimulation (DBS) (subthalamic nucleus,STN) based on the center of the red nucleus (RN).Methods Sixteen adults,including 8 with Parkinson' s disease (PD) and 8 from healthy volunteers,collected in our hospital from September 2012 to September 2013,were chosen; transverse T2-weighted MRI (3.0T) was performed.On the layer of the RN's maximum diameter,a right triangle was formed by three lines:the first one (marked as line AB) was the acknowledged 12 mm line,the second one (marked as line AC) was connected by the operation target and the RN center,and the third one (marked as line BC) was connected by the anterior commissure (AC) and posterior commissure (PC).The angle (marked as α) formed by the AC-PC plane and line AC and the length of the line BC (marked as b) were measured and analyzed.Results The average length of the RN diameter in 16 adults was (0.93±0.05) cm in the left cerebral hemisphere and (0.92±0.03) cm in the right.The length of line b was (0.81 ±0.09) cm in the left and (0.82±0.06) cm in the right.The angle α was (56.76±2.87)° in the left and (55.98±2.30)° in the right.The RN diameter,length of line b and angle α in patients from PD group showed no significant differences as compared with those in the normal controls (P＞0.05).Conclusion The RN center can be used for indirectly locating STN before DBS for PD treatment.