Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 1959  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  » Next article
  » Previous article 
  » Table of Contents
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
  »  Article in PDF (239 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
 »  References

 Article Access Statistics
    Viewed1815    
    Printed57    
    Emailed1    
    PDF Downloaded78    
    Comments [Add]    
    Cited by others 3    

Recommend this journal

 


 
CORRESPONDENCE
Year : 2010  |  Volume : 58  |  Issue : 3  |  Page : 503

The need for more evidence-based reporting in deep brain stimulation


25 bis rue des Envierges, 75020 Paris, France

Date of Acceptance17-Jun-2010
Date of Web Publication17-Jul-2010

Correspondence Address:
Christian Saleh
25 bis rue des Envierges, 75020 Paris
France
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.65536

Rights and Permissions



How to cite this article:
Saleh C. The need for more evidence-based reporting in deep brain stimulation. Neurol India 2010;58:503

How to cite this URL:
Saleh C. The need for more evidence-based reporting in deep brain stimulation. Neurol India [serial online] 2010 [cited 2019 Sep 20];58:503. Available from: http://www.neurologyindia.com/text.asp?2010/58/3/503/65536


Sir,

Doshi and Bhargava provide an interesting report on the relation between deep brain stimulation of the subthalamic nucleus (STN) and hypersexuality [1] and conclude that "this is probably the first case report where manifestation of hypersexuality is a predominant behavioral side effect of successful STN stimulation." It is regrettable though that the authors while deducing important clinical conclusions from the localization of the contacts do not document the electrode localization and refer, as to their surgical intervention, solely to their previous published article. [2] The previous article [2] does not provide, however, the crucial specifics indispensable in the evaluation and understanding of the newly presented cases. [1] Furthermore, one wonders why no attempt was made (in the second patient) to change the localization of the stimulating contacts and the stimulating parameters. The question, if the observed hypersexuality was secondary to the specific position of the contacts or due to stimulation remains unanswered.

The "significant improvement" of motor function noted in the 2 patients could have been due to stimulation of the adjacent dorsal structures of the STN as reported by Godinho and colleagues, [3] rather than to the STN. It remains quite intriguing why hypersexuality, if related to STN stimulation, is not reported more frequently, given the myriad of deep brain stimulation (DBS) STN interventions. Since the aberrant behavior resolved abruptly in patient 1 without changing the stimulation settings and was controlled in the second patient with antipsychotic medications, the hypothesis of STN stimulation-induced hypersexuality seems even less tenable. Hypersexuality is a complex pathologic phenomenon as described by Poeck and Pilleri in their important study, [4] involving lesions in "basal ganglia and limbic midline structures" and usually encountered within the context of mania, which in the DBS literature is reported with substantia nigra rather than with STN stimulation. The precipitate attribution of highly specific functions to basal ganglia nuclei, such as the STN will lead solely to a clouding of our understanding as to the specific functionality of the tightly packed and complex basal ganglia network. The statement that "This is probably the first case report where manifestation of hypersexuality is a predominant behavioral side effect of successful STN stimulation" should therefore be made with due caution. The detailing of the surgical procedure in these 2 patients and a postoperative scan would have presumably shed light on this important matter.

 
 » References Top

1.Doshi P, Bhargava P. Hypersexuality following subthalamic nucleus stimulation for Parkinson's disease. Neurol India 2008;56:474-6.  Back to cited text no. 1  [PUBMED]  Medknow Journal  
2.Doshi PK, Chhaya NA, Bhatt MA. Bilateral subthalamic nucleus stimulation for Parkinson's disease. Neurol India 2003;51:43-8.  Back to cited text no. 2  [PUBMED]  Medknow Journal  
3.Godinho F, Thobois S, Magnin M, Guenot M, Polo G, Benatru I, et al. Subthalamic nucleus stimulation in Parkinson's disease: Anatomical and electrophysiological localization of active contacts. J Neurol 2006;253:1347-55.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Poeck K, Pilleri G. Release of hypersexual behaviour due to lesion in the limbic system. Acta Neurol Scand 1965;41:233-44.  Back to cited text no. 4  [PUBMED]    



This article has been cited by
1 The need for a multifactorial approach to raise the standard in deep brain stimulation reporting
Saleh, C., Gale, J.T., Eskandar, E.
Neuromodulation. 2011; 14(2): 183-184
[Pubmed]
2 The Need for a Multifactorial Approach to Raise the Standard in Deep Brain Stimulation Reporting
Christian Saleh,John T. Gale,Emad Eskandar
Neuromodulation: Technology at the Neural Interface. 2011; 14(2): 183
[Pubmed] | [DOI]
3 DBS: Should the STN be avoided in progressive Parkinsonęs disease?
Saleh, C.
Acta Neurochirurgica. 2010; 152(12): 2101-2102
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow