PMC7869408_01
Deep Brain Stimulator. Panel (A) shows a schematic of Deep Brain Stimulation (DBS) electrodes placed on the ventral capsule/ventral striatum with four different electrodes placed from ventral (0) to dorsal (3; image used with permission from Medtronics). Panel (B) shows the head CT of the patient, revealing the more ventral and anterior position of the left electrode.
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F1
A 57-year-old right-handed single Caucasian male with a history of severe, treatment-resistant MDD since the age of 20 and a Deep Brain Stimulator implanted bilaterally in the VC/VS (Figure 1A) 32 months before admission, presented to the Emergency Room of the Massachusetts General Hospital complaining of 2 weeks of brief transient episodes, lasting 20 s to 2 min, of abrupt-onset and progressively louder coprolalia; tic-like motor behavior in his right arm or leg; rushes of anxiety, angry prosody, angry affect; and moderate amnesia without confusion. On closer radiographic analysis of DBS electrodeposition, the left stimulator was observed to be more ventral and rostral than the right (Figure 1B).
Behavioral and motor manifestation. Drawings made by the patient on a hospital menu during one of the events with right-hand movements.
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F2
During one of the events, as he was completing his breakfast preferences in the hospital menu, an episode started and he continued drawing circles on the paper in what seemed to be a mix of jerk-like movements and transient perseveration (Figure 2).