Objective: To present two cases of DBS stimulation of globus pallidus (GPi) with acute and reproducible laughter associated with stimulation and review the possible underlying mechanism.

Background: The GPi is a longstanding and effective target for treatment of motor symptoms of dystonia and Parkinson disease (PD). The anteromedial GPi has also been utilized as a DBS target for Tourette’s and OCD, for it’s limbic connections. Stimulation induced laughter has been reported with stimulation of the anterior limb of internal capsule and nucleus accumbens, as well as STN. There are reports of behavioral disturbance associated with chronic stimulation of GPi and a case of acute crying, however no reports of acute laughter with GPi stimulation exist. We reviewed the DBS electrode maps and stimulation parameters in two cases of GPi stimulation induced laughter and the potential underlying neuroanatomical correlates.

Method: We present two cases with acute laughter after GPi stimulation during threshold mapping. In both cases, 0.5mm spacing leads were implanted.

Results: Case 1: 26-year-old woman with cervical dystonia who underwent bilateral GPi DBS lead placement. One month after surgery she had threshold mapping, where reproducible laughter with acute stimulation of the two superior most contacts was seen. Stimulation of the right GPi at C+L3-/2.0 mA/60us/130Hz resulted in laughter. This was also seen at C+L4-/2.0 mA/60us/130Hz. Lead-map coordinates for contact L3 were 21.0mm lateral, 5.4mm anterior, and 0.5mm inferior from mid-commissural point (MCP). Lead-map coordinates for contact L4 were 21.1mm lateral, 6.3mm anterior, and 1.3mm superior from MCP.

Case 2: 74-year-old man with PD with a history of left GPi DBS, underwent right GPi lead placement about 1.5 years later. Threshold mapping revealed reproducible laughter at right GPi, settings at C+L4-/2.5mA/60us/130Hz. The second time he was stimulated at these settings, 10-15 minutes after initial stimulation, there was a delayed response with laughter. Lead-map coordinates of contact L4 were 19.8 mm lateral, 5.1mm anterior, and 3.1mm superior from MCP.

Conclusion: In both cases, stimulation of the superior-most contacts of the DBS leads resulted in laughter. Lead maps showed these contacts to be at the anterior GPi/GPe junction. A potential mechanism underlying this behavioral response may be secondary to stimulation of anterior GPi and its connections to limbic cortical regions.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/acute-reversible-laughter-with-globus-pallidus-interna-stimulation/