Table 1
Deep brain stimulation (DBS) parameters associated with psychiatric symptoms. STN: Subthalamic nucleus.
| TIME AFTER DBS PLACEMENT | SYMPTOMS | SETTINGS ASSOCIATED WITH SYMPTOMS | SETTINGS ASSOCIATED WITH RESOLUTION OF SYMPTOMS | ||
|---|---|---|---|---|---|
| LEFT STN | RIGHT STN | LEFT STN | RIGHT STN | ||
| 6 months | Impulsivity | C+1–2.5 V, 60 µs, 140 Hz | STN1: C+1–2.5 V, 60 µs, 125 Hz | C+2–2.6 V, 60 µs, 140 Hz | C+1–2.5 V, 60 µs, 140 Hz |
| STN2: C+2–2.0 V, 60 µs, 125 Hz | |||||
| 17 months | Impulsivity, euphoria and hypersexuality | C+1–2–2.5 V, 60 µs, 185 Hz | STN1: C+1–3.5 V, 60 µs, 125 Hz | C+2–2.8 V, 60 µs, 180 Hz | STN1: C+1–2.8 V, 60 µs, 125 Hz |
| STN2: C+3–2.9 V, 60 µs, 125 Hz | STN2: C+3–2.0 V, 60 µs, 125 Hz | ||||
| 18 months | Impulsivity, euphoria and hypersexuality | C+1–2–2.5 V, 60 µs, 180 Hz | STN1: C+1–2.8 V, 60 µs, 125 Hz | C+2–2.8 V, 60 µs, 180 Hz | STN1: C+1–2.8 V, 60 µs, 125 Hz |
| STN2: C+3–2.0 V, 60 µs, 125 Hz | STN2: C+3–2.0 V, 60 µs, 125 Hz | ||||
Video 1
DBS-induced mood shift. Activation of contact 1 on the left side elicited immediate euphoric behavior, including pacing, squatting, and grabbing the examiner. Returning to baseline settings resolved the symptoms.
DBS: Deep brain stimulation.
Figure 1
Imaging analysis of the lead location and stimulation regions that induced elevated mood. (A) Segmentations of the bilateral STN at the level of contact 1 (marked with white circles) overlaid on the preoperative T2 MRI. (B) Bilateral DBS lead locations relative to the limbic, associative, and motor subregions of the STN from the DISTAL atlas (23) nonlinearly registered to the patient’s imaging. (C) Models of the VTAs generated by the stimulation parameters that induced elevated mood (light purple) and no mood symptoms at baseline (dark purple). Stimulation of the left ventromedial STN was associated with elevated mood. (D) The percentage of the total STN and motor, associative, and limbic subregions overlapping with the VTAs shown in (C). Stimulation parameters that were associated with elevated mood showed higher VTA overlap with the STN and all subregions, with particularly high increases in VTA overlap with the associative/limbic subregions. Right-sided stimulation was less implicated in elevated mood, despite similar levels of VTA overlap with associative/limbic subregions.