Successful Treatment of Psychiatric Symptoms after Traumatic Brain Injury Using Deep Brain Stimulation to the Anterior Limb of Internal Capsule-Nucleus Accumbens
bin zhou 1, weiping kuang 1, hongxing huang 1, yong zhu 1, xiaofeng chen 1, liang li 2, ping yang 1*
1Department of neurosurgery, Brain Hospital of Hunan Province, Clinical Medical School of Hunan University of Chinese Medicine, 2Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine
Received: April 29, 2019; Revised: July 6, 2019; Accepted: July 29, 2019; Published online: July 29, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Psychiatric symptoms are common after traumatic brain injury (TBI), and some patients have poor drug therapeutic efficacy. We report a successfully treated case of psychiatric symptoms after TBI using deep brain stimulation (DBS) to the anterior limb of internal capsule (ALIC) -nucleus accumbens (NAc) in a 76-year-old woman. The patient suffered from auditory hallucination, mood changes, and insomnia caused by TBI. Psychological test assessment showed the scores of Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and Positive and Negative Syndrome Scale (PANSS) were 30, 35 and 96 respectively. Head magnetic resonance imaging (MRI) scan showed right temporal lobe encephalomalacia. Head magnetic resonance spectroscopy (MRS) showed bilateral basal ganglia choline (Cho) increased relatively. After DBS to the ALIC-NAc, the target parameters were adjusted. The psychiatric symptoms were completely improved and the result of head MRS was normal in the end. The current report declares that DBS is reversible, adjustable and safe in the treatment of psychiatric symptoms caused by TBI. DBS to the ALIC-NAc should be considered as a possible treatment choice once a patient showed psychiatric symptoms after TBI.
Keywords: Deep brain stimulation, Traumatic brain injury, Psychiatric symptoms, Anterior limb of internal capsule, Nucleus accumbens


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