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Compulsive thalamic self-stimulation: a case with metabolic, electrophysiologic and behavioral correlates
Russell K Portenoy1, Jens O Jarden, John J Sidtis
1Unified Pain Service and Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, U.S.A. Pain Service and Department of Neurology, Memorial Sloan-Kettering Cancer Center and Cornell University Medical College, New York, NY U.S.A.
Pain
|December 1, 1986
Summary
Compulsive self-stimulation and altered autonomic and neurologic function occurred in a patient receiving deep brain stimulation. Unilateral thalamic stimulation caused widespread brain changes and potential addiction.
Area of Science:
- Neuroscience
- Neurology
- Endocrinology
Background:
- Deep brain stimulation (DBS) is used for treating neurological disorders.
- The ventralis posterolateralis nucleus of the thalamus plays a role in sensory processing.
Observation:
- A patient with a thalamic DBS electrode developed compulsive self-stimulation with erotic sensations.
- Stimulation led to changes in autonomic function (increased vital signs, pupillary diameter) and neurological status (left hemiparesis, hemisensory loss).
- Cognitive functions shifted, with verbal abilities declining and visuospatial processing improving.
Findings:
- Endocrine changes included decreased growth hormone and increased adrenocorticotrophic hormone and cortisol.
- Positron emission tomography revealed increased glucose metabolism in the thalami and hemispheres, reversing baseline asymmetries.
- Electroencephalography and evoked potentials showed no change, except for visual evoked potentials indicating left anterior visual pathway dysfunction.
Implications:
- This case highlights the potential for addiction to deep brain stimulation.
- Unilateral thalamic stimulation can induce significant behavioral, physiological, and metabolic changes.
- Further research is needed to understand the mechanisms and risks of DBS-induced behavioral changes.