Compulsive thalamic self-stimulation: a case with metabolic, electrophysiologic and behavioral correlates.
A 48-year-old woman with a stimulating electrode implanted in the right thalamic nucleus ventralis posterolateralis developed compulsive self-stimulation associated with erotic sensations and changes in autonomic and neurologic function. Stimulation effects were evaluated by neuropsychologic testing, endocrine studies, positron emission tomographic measurements of regional cerebral metabolic rate for glucose, EEG and evoked potentials. During stimulation, vital signs and pupillary diameter increased and a left hemiparesis and left hemisensory loss developed. Verbal functions deteriorated and visuospatial processing improved. Plasma growth hormone concentrations decreased, and adrenocorticotrophic hormone and cortisol levels rose. With stimulation, glucose metabolism increased in both thalami and both hemispheres, reversing baseline right-sided hypometabolism and right-left asymmetries. EEG and both somatosensory and brain-stem auditory evoked potentials remained unchanged during stimulation, while visual evoked potentials revealed evidence of anterior visual pathway dysfunction in the left eye. This case establishes the potential for addiction to deep brain stimulation and demonstrates that widespread behavioral and physiological changes, with concomitant alteration in the regional cerebral metabolic rate for glucose, may accompany unilateral thalamic stimulation.
D001921:Brain / Q000378:metabolism*; D003192:Compulsive Behavior / Q000378:metabolism / Q000503:physiopathology*; D003847:Deoxyglucose / Q000031:analogs & derivatives; D005071:Evoked Potentials; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism*; D006728:Hormones / Q000097:blood; D006801:Humans; D008875:Middle Aged; D009483:Neuropsychological Tests; D059408:Pain Management; D012653:Self Stimulation / Q000502:physiology*; D012725:Sexual Behavior / Q000502:physiology; D013787:Thalamic Nuclei / Q000502:physiology*; D014055:Tomography, Emission-Computed
D006728:Hormones; D019788:Fluorodeoxyglucose F18; D003847:Deoxyglucose; D005947:Glucose