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Background: Mood, cognitive, and behavioural changes have been reported with deep brain stimulation (DBS) in the thalamus, globus pallidus interna, and anterior limb of the internal capsule/nucleus accumbens region. Objective: To investigate panic and fear resulting from DBS. Methods: Intraoperative DBS in the region of the right and then left anterior limb of the internal capsule and nucleus accumbens region was undertaken to treat a 52 year old man with treatment refractory obsessive-compulsive disorder (OCD). Mood, anxiety, OCD, alertness, heart rate, and subjective feelings were recorded during intraoperative test stimulation and at follow up programming sessions. Results: DBS at the distal (0) contact (cathode 0-, anode 2+, pulse width 210 ms, rate 135 Hz, at 6 volts) elicited a panic attack (only seen at the (0) contact). The patient felt flushed, hot, fear ful, and described himself as having a “panic attack.“ His heart rate increased from 53 to 111. The effect (present with either device) was witnessed immediate ly after turning the device on, and abruptly ceased in the off condition. Conclu sions: DBS of the anterior limb of the internal capsule and nucleus accumbens re gion caused severe “panic.” This response may result from activation of limbic and autonomic networks.
Background: Mood, cognitive, and behavioral changes have been reported with deep brain stimulation (DBS) in the thalamus, globus pallidus interna, and anterior limb of the internal capsule / nucleus accumbens region. Objective: To investigate panic and fear resulting from DBS. Methods: Intraoperative DBS in the region of the right and then left anterior limb of the internal capsule and nucleus accumbens region was undertaken to treat a 52 year old man with treatment refractory obsessive-compulsive disorder (OCD). Mood, anxiety, OCD, alertness , heart rate, and subjective feelings were recorded during intraoperative test stimulation and at follow up programming sessions. Results: DBS at the distal (0) contact (cathode 0-, anode 2+, pulse width 210 ms, rate 135 Hz, at 6 volts) elicited a panic attack (only seen at the (0) contact). The patient felt flushed, hot, fear ful, and described himself as having a “panic attack.” His heart rate increased from 53 to 111. The effect (present with either device) was witnessed immediate ly after turning the device on, and abruptly ceased in the off condition. Conclu sions: DBS of the anterior limb of the internal capsule and nucleus accumbens re gion caused severe “panic. ” This response may result from activation of limbic and autonomic networks.