title: Deep Brain Stimulation of the Basolateral Amygdala: Targeting Technique and Electrodiagnostic Findings.
abstract: The amygdala plays a critical role in emotion regulation. It could prove to be an effective neuromodulation target in the treatment of psychiatric conditions characterized by failure of extinction. We aim to describe our targeting technique, and intra-operative and post-operative electrodiagnostic findings associated with the placement of deep brain stimulation (DBS) electrodes in the amygdala. We used a transfrontal approach to implant DBS electrodes in the basolateral nucleus of the amygdala (BLn) of a patient suffering from severe post-traumatic stress disorder. We used microelectrode recording (MER) and awake intra-operative neurostimulation to assist with the placement. Post-operatively, the patient underwent monthly surveillance electroencephalograms (EEG). MER predicted the trajectory of the electrode through the amygdala. The right BLn showed a higher spike frequency than the left BLn. Intra-operative neurostimulation of the BLn elicited pleasant memories. The monthly EEG showed the presence of more sleep patterns over time with DBS. BLn DBS electrodes can be placed using a transfrontal approach. MER can predict the trajectory of the electrode in the amygdala and it may reflect the BLn neuronal activity underlying post-traumatic stress disorder PTSD. The EEG findings may underscore the reduction in anxiety.
authors: Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. jean-philippe.langevin@va.gov.
authors: Jean-Philippe
authors: JP
authors: Langevin
authors: Neurology Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. james.chen1@va.gov.
authors: James W Y
authors: JW
authors: Chen
authors: Psychiatry and Mental Health Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. ralph.koek@va.gov.
authors: Ralph J
authors: RJ
authors: Koek
authors: Psychiatry and Mental Health Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. david.sultzer@va.gov.
authors: David L
authors: DL
authors: Sultzer
authors: Radiology Service, Nuclear Medicine VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. mark.mandelkern@va.gov.
authors: Mark A
authors: MA
authors: Mandelkern
authors: Psychiatry and Mental Health Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. holly.schwartz@va.gov.
authors: Holly N
authors: HN
authors: Schwartz
authors: Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. scott.krahl@va.gov.
authors: Scott E
authors: SE
authors: Krahl
keywords: PTSD; amygdala; basolateral nucleus; deep brain stimulation; microelectrode recording; targeting technique