title: Reward circuit DBS improves Parkinson's gait along with severe depression and OCD.
abstract: A 59-year-old Caucasian man with a past history of Parkinson's disease (PD) status post-bilateral subthalamic nucleus (STN) deep brain stimulation (DBS), who also had treatment-resistant (TR) obsessive-compulsive disorder (OCD), and treatment-resistant depression (TRD), presented for further evaluation and management of his TR OCD. After an unsuccessful attempt to treat his OCD by reprogramming his existing STN DBS, he was offered bilateral ventral capsule/ventral striatum (VC/VS) DBS surgery. In addition to the expected improvement in OCD symptoms, he experienced significant improvement in both PD-related apathy and depression along with resolution of suicidal ideation. Furthermore, the patient's festinating gait dramatically improved. This case demonstrates that DBS of both the STN and VC/VS appears to have an initial signal of safety and tolerability. This is the first instance where both the STN and the VC/VS DBS targets have been implanted in an individual and the first case where a patient with PD has received additional DBS in mood-regulatory circuitry.
authors.affiliation: a Department of Psychiatry , Stanford University , Stanford , CA , USA.
authors.forename: Nolan R
authors.initials: NR
authors.lastname: Williams
authors.affiliation: b Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Hopkins
authors.affiliation: b Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: E Baron
authors.initials: EB
authors.lastname: Short
authors.affiliation: b Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Sahlem
authors.affiliation: b Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Snipes
authors.affiliation: c Department of Neurosciences , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Gonzalo J
authors.initials: GJ
authors.lastname: Revuelta
authors.affiliation: b Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA.|c Department of Neurosciences , Medical University of South Carolina , Charleston , SC , USA.|d Ralph H. Johnson VA Medical Center , Charleston , SC , USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: George
authors.affiliation: c Department of Neurosciences , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Istvan
authors.initials: I
authors.lastname: Takacs
mesh_terms: D057565:Apathy; D046690:Deep Brain Stimulation / Q000379:methods*; D003865:Major Depressive Disorder / Q000150:complications / Q000628:therapy; D020233:Gait Disorders, Neurologic / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000628:therapy; D010300:Parkinson Disease / Q000150:complications*; D011569:Psychiatric Status Rating Scales; D012201:Reward; D020531:Subthalamic Nucleus / Q000502:physiology
keywords: Deep brain stimulation; Parkinson’s disease; apathy; depression; obsessive–compulsive disorder