Case report: Turning on the left side electrode changed depressive state to manic state in a Parkinson’s disease patient who received bilateral subthalamic nucleus deep brain stimulation (STN-DBS)
Makoto Kinoshita 1*, Masahito Nakataki 1, Ryoma Morigaki 2, 3, 4, Satsuki Sumitani 1, 5, Satoshi Goto 2, 3, Ryuji Kaji 3, 6, Tetsuro Ohmori 1
1Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, 2Department of Neurodegenerative Disorders Research, Institute of Biomedical Sciences, Graduate School of Medical Sciences, Tokushima University, 3Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, 4Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medical Sciences, Tokushima University, 5Department of Support for Students with Special Needs, Institute of Biomedical Sciences, Tokushima University Graduate School, 6Department of Clinical Neuroscience, Institute of Health Biosciences, Graduate School of Medical Sciences, Tokushima University
Received: January 10, 2017; Revised: February 24, 2017; Accepted: March 20, 2017; Published online: March 20, 2017.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
No previous reports have described a case in which deep brain stimulation elicited an acute mood swing from a depressive to manic state simply by switching one side of the bilateral deep brain stimulation electrode on and off. The patient was a 68-year-old woman with a 10-year history of PD. She underwent bilateral subthalamic deep brain stimulation surgery. After undergoing surgery, the patient exhibited hyperthymia. She was scheduled for admission. On the first day of admission, it was clear that resting tremors in the right limbs had relapsed and her hyperthymia had reverted to depression. It was discovered that the left-side electrode of the deep brain stimulation device was found to be accidentally turned off. As soon as the electrode was turned on, motor impairment improved and her mood switched from depression to mania. The authors speculate that the lateral balance of stimulation plays an important role in mood regulation. The current report provides an intriguing insight into possible mechanisms of mood swing in mood disorders.
Keywords: Subthalamic nucleus deep brain stimulation, Parkinson’s disease, Manic episode, Depressive episode, Lateral balance


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