深部脑刺激诱发的惊恐和恐惧。
Panic and fear induced by deep brain stimulation.
作者信息
Shapira N A, Okun M S, Wint D, Foote K D, Byars J A, Bowers D, Springer U S, Lang P J, Greenberg B D, Haber S N, Goodman W K
机构信息
Department of Psychiatry, University of Florida, Gainesville, FL, USA.
出版信息
J Neurol Neurosurg Psychiatry. 2006 Mar;77(3):410-2. doi: 10.1136/jnnp.2005.069906.
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, fearful, and described himself as having a "panic attack." His heart rate increased from 53 to 111. The effect (present with either device) was witnessed immediately after turning the device on, and abruptly ceased in the off condition
CONCLUSIONS
DBS of the anterior limb of the internal capsule and nucleus accumbens region caused severe "panic." This response may result from activation of limbic and autonomic networks.
背景
已有报道称，丘脑、苍白球内侧部以及内囊/伏隔核区域的前肢进行深部脑刺激（DBS）会引发情绪、认知和行为变化。
目的
研究DBS引发的惊恐和恐惧。
方法
对一名52岁难治性强迫症（OCD）男性患者，在右侧内囊前肢和伏隔核区域，然后是左侧进行术中DBS治疗。术中测试刺激期间以及随访程控时记录情绪、焦虑、OCD、警觉性、心率和主观感受。
结果
在远端（0）触点（阴极0 -，阳极2 +，脉宽210毫秒，频率135赫兹，6伏）进行DBS引发了一次惊恐发作（仅在（0）触点时出现）。患者感到脸红、发热、恐惧，并自述有“惊恐发作”。他的心率从53次/分钟增加到111次/分钟。打开设备后立即出现这种效应（两种设备均如此），关闭设备后效应突然停止。
结论
内囊前肢和伏隔核区域的DBS会引发严重的“惊恐”。这种反应可能源于边缘系统和自主神经系统网络的激活。
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