title: Behind the screen: pseudobulbar symptoms after deep brain stimulation.
abstract: BACKGROUND
  Thalamotomy was formerly used to treat different tremor syndromes. Nowadays, deep brain stimulation has become an established technique to treat -different movement disorders. The combination of these two stereotactic interventions is rare.
  
  
  METHODS
  We present a patient in which a right-sided tremor -syndrome with an underlying pathology of combined essential tremor and Parkinsonian tremor was successfully treated initially with a left-sided thalamotomy and subsequently with -bilateral deep brain stimulation in the subthalamic nucleus.
  
  
  RESULTS
  Deep brain stimulation in the subthalamic nucleus resulted in hemidystonia, pathological laughing and crying, dysarthria and dysphagia, all due to dislocation of the stimulation electrodes contacting the internal capsule. After discontinuation of the high-frequency stimulation these side-effects disappeared, but were then reactivated by an LCD television in stand-by mode.
  
  
  CONCLUSIONS
  In this report we discuss the pathophysiology of pseudobulbar symptoms and pathological laughing and crying in context of thalamotomy and dislocated DBS electrodes. Furthermore, we report on the occurrence that magnetic fields in the household have an impact on deep brain stimulation, even if they are in stand-by mode.
authors: Department of Neurology, University Medical Center Freiburg, Breisacherstr. 64, Freiburg, 79106, Germany, florian.amtage@uniklinik-freiburg.de.
authors: Florian
authors: F
authors: Amtage
authors: Johann
authors: J
authors: Lambeck
authors: Sebastian
authors: S
authors: Rutsch
authors: Thomas
authors: T
authors: Prokop
authors: Marcus
authors: M
authors: Pinsker
authors: Michel
authors: M
authors: Rijntjes
mesh_terms: D046690:Deep Brain Stimulation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D020828:Pseudobulbar Palsy / Q000175:diagnosis / Q000209:etiology*; D020531:Subthalamic Nucleus / Q000502:physiology*; D014057:Tomography, X-Ray Computed; D014202:Tremor / Q000628:therapy