Pharmacological treatment of deep brain stimulation-induced hypomania leads to clinical remission while preserving motor benefits

Abstract

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for Parkinson's disease, but can lead to adverse effects including psychiatric disturbance. Little is known about the risk factors and treatment options for such effects. Here, we describe a patient who reproducibly developed stimulation-induced hypomania when using ventrally located electrodes and responded well to pharmacological intervention while leaving the stimulation parameters unchanged to preserve motor benefits. In spite of clinical remission, [¹⁵O]-positron-emission-tomography (PET) demonstrated activation patterns similar to those reported during mania. This case, therefore, highlights an important treatment option of adverse effects of DBS, but also points toward the need for investigations of its risk factors and their underlying neurobiological mechanisms.

Keywords:

• Subthalamic nucleus
• Deep brain stimulation
• Parkinson's disease
• Stimulation-induced hypomania
• Pharmacological treatment
• Positron-emission-tomography (PET)

Acknowledgments

L.S. gratefully acknowledges Esther Florin's help in anatomically localizing the electrodes by means of image fusion. L.S. is also grateful to Carolin Urbach and Eun-Hae Kim for their involvement in patient care and to David Sharp for helpful comments on an earlier version of the manuscript. The authors thank the PET group of the Physics of Medical Imaging Section of the Institute of Neuroscience and Medicine (INM-4, Research Centre Juelich), especially Professor Hans Herzog, for their expert assistance. The authors have no conflicts of interests to declare.