Panic and fear induced by deep brain stimulation.
BACKGROUND
Mood, cognitive, and behavioural changes have been reported with deep brain stimulation (DBS) in the thalamus, globus pallidus interna, and anterior limb of the internal capsule/nucleus accumbens region.


OBJECTIVE
To investigate panic and fear resulting from DBS.


METHODS
Intraoperative DBS in the region of the right and then left anterior limb of the internal capsule and nucleus accumbens region was undertaken to treat a 52 year old man with treatment refractory obsessive-compulsive disorder (OCD). Mood, anxiety, OCD, alertness, heart rate, and subjective feelings were recorded during intraoperative test stimulation and at follow up programming sessions.


RESULTS
DBS at the distal (0) contact (cathode 0-, anode 2+, pulse width 210 ms, rate 135 Hz, at 6 volts) elicited a panic attack (only seen at the (0) contact). The patient felt flushed, hot, fearful, and described himself as having a "panic attack." His heart rate increased from 53 to 111. The effect (present with either device) was witnessed immediately after turning the device on, and abruptly ceased in the off condition


CONCLUSIONS
DBS of the anterior limb of the internal capsule and nucleus accumbens region caused severe "panic." This response may result from activation of limbic and autonomic networks.
Shapira
N A
NA
Department of Psychiatry, University of Florida, Gainesville, FL, USA.
Okun
M S
MS
Wint
D
D
Foote
K D
KD
Byars
J A
JA
Bowers
D
D
Springer
U S
US
Lang
P J
PJ
Greenberg
B D
BD
Haber
S N
SN
Goodman
W K
WK
D001007:Anxiety / Q000503:physiopathology; D001143:Arousal / Q000502:physiology; D001341:Autonomic Nervous System / Q000503:physiopathology; D001931:Brain Mapping; D004292:Dominance, Cerebral / Q000502:physiology; D004558:Electric Stimulation; D004599:Electric Stimulation Therapy; D005239:Fear / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D009415:Nerve Net / Q000503:physiopathology; D009714:Nucleus Accumbens / Q000503:physiopathology*; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D010200:Panic / Q000502:physiology*; D019736:Prostheses and Implants; D014057:Tomography, X-Ray Computed