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Case Report: Deep Brain Stimulation to the Ventral Internal Capsule/Ventral Striatum Induces Repeated Transient Episodes of Voltage-Dependent Tourette-Like Behaviors
Frontiers in Human Neuroscience ( IF 2.9 ) Pub Date : 2021-01-25 , DOI: 10.3389/fnhum.2020.590379
Joan A. Camprodon , Tina Chou , Abigail A. Testo , Thilo Deckersbach , Jeremiah M. Scharf , Darin D. Dougherty

Deep Brain Stimulation (DBS) is an invasive device-based neuromodulation technique that allows the therapeutic direct stimulation of subcortical and deep cortical structures following the surgical placement of stimulating electrodes. DBS is approved by the U.S. Federal Drug Administration for the treatment of movement disorders and obsessive-compulsive disorder, while new indications, including Major Depressive Disorder (MDD), are in experimental development. We report the case of a patient with MDD who received DBS to the ventral internal capsule and ventral striatum bilaterally and presented with 2 weeks of voltage-dependent Tourette-like symptoms including brief transient episodes of abrupt-onset and progressively louder coprolalia and stuttered speech; tic-like motor behavior in his right arm and leg; rushes of anxiety, angry prosody, angry affect; and moderate amnesia without confusion. We describe the results of the inpatient neuropsychiatric workup leading to the diagnosis of iatrogenic voltage-dependent activation of cortico-subcortical circuits and discuss insights into the pathophysiology of Tourette as well as safety considerations raised by the case.

中文翻译:

病例报告:对腹侧内囊/腹侧纹状体的深部脑刺激诱导反复瞬态发作的电压依赖性图雷特样行为

脑深部刺激 (DBS) 是一种基于侵入性设备的神经调节技术,允许在手术放置刺激电极后对皮层下和皮层深部结构进行治疗性直接刺激。DBS 已被美国联邦药物管理局批准用于治疗运动障碍和强迫症,而包括重度抑郁症 (MDD) 在内的新适应症正在实验开发中。我们报告了一个 MDD 患者的病例,他接受了双侧腹侧内囊和腹侧纹状体 DBS,并出现了 2 周的电压依赖性图雷特样症状,包括短暂的突然发作和逐渐变大的耳鸣和口吃;右臂和右腿出现抽动样运动行为;焦虑的涌动,愤怒的韵律,愤怒的情绪;和中度健忘症,没有混淆。我们描述了住院神经精神病学检查的结果,导致诊断出皮质-皮质下回路的医源性电压依赖性激活,并讨论了对抽动秽语的病理生理学的见解以及病例提出的安全考虑。
更新日期:2021-01-25
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