Objective: To report on a patient with Parkinsons’ disease (PD) who developed pathologic crying (PC) following chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN).

Background: STN DBS has been established as an effective and safe therapy for patients with PD. Stimulation-induced side effects like vertigo, dizziness and dysarthria have been reported frequently. Pathological crying is a disorder of emotional expression characterized by episodic crying inappropriate to the own emotional experience, independent of any underlying mood disorder.

Methods: We report on a 66 year-old man with an idiopathic PD since the age of 56 years, who developed severe fluctuations and therefore underwent STN DBS at the age of 64 years. A comprehensive pre-operative neurologic, neuropsychologic and psychiatric assessment as well as magnetic resonance imaging (MRI) of the brain was performed. During regular postoperative follow-up (FU) every three months the clinical course was documented.

Results: Preoperative assessment showed moderate white matter lesions on MRI. Neuropsychologic assessment revealed mild executive dysfunctions. The preoperative UPDRS (III) motor score varied between 37 (on) and 49 (off). DBS implantation was unremarkable, postoperative imaging confirmed correct placement of the electrodes. Bilateral monopolar stimulation (second-most upper contacts, 2.4V, 130Hz, 60µs) was applied. Consequently, tremor and motor fluctuations significantly improved (UPDRS (III) motor score 21). In the course of time, however, the patient rapidly started to cry without a specific trigger while watching television without feeling sad or depressed. He had never presented such symptoms prior to DBS. During regular FUs (last FU 21 months post-OP) he continuously reported these symptoms at each consultation. Since motor symptoms were improved he was reluctant to any modification of stimulation settings.

Conclusions: This case adds some more evidence to the few previous reports that PC might occur as a rare side effect of STN DBS in PD. Current spread to adjacent structures of the STN might lead to a disruption of cortico-bulbo-cerebellar pathways accountable for PC. Patients might not complain about, since either they feel embarrassed or may believe that symptoms are part of an unswayable disease course. Therefore, treating physicians should actively ask for PC.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pathological-crying-induced-by-deep-brain-stimulation-of-the-subthalamic-nucleus-in-parkinsons-disease/