Smile without euphoria induced by deep brain stimulation: a case report

Abstract

Poststroke central pain (PSCP) can be a debilitating medication-refractory disorder. We report a single case where right unilateral ventral capsule/ventral striatum (VC/VS) deep brain stimulation was used to treat PSCP and inadvertently induced a smile without euphoria. The patient was a 69 year-old woman who had a stroke with resultant dysesthesia and allodynia in her left hemibody and also a painful left hemibody dystonia. In her case, VC/VS stimulation induced a smile phenomenon, but without a euphoric sensation. This phenomenon was different from the typical smile responses we have observed in obsessive-compulsive disorder cases. This difference was considered to be possibly attributable to impairment in the emotional smile pathway.

Brain Stimulation Therapy for Central Post-Stroke Pain from a Perspective of Interhemispheric Neural Network Remodeling

“…Recently, neuropsychiatric DBS approaches have been applied to address the affective components of pain in pain disorders. The DBS targets included limbic structures, the anterior cingulate cortex (ACC; Boccard et al, 2014a , b ), and the ventral capsule/ventral striatum (VC/VS; Machado et al, 2013 ; Morishita et al, 2015a ). The ACC stimulation was applied based on the experience of anterior cingulotomy for intractable pain and obsessive-compulsive disorder (OCD; Brotis et al, 2009 ).…”

“…Boccard et al reported favorable outcomes in the pain levels and QOL of 11 patients who had follow-up evaluations after bilateral ACC DBS (Boccard et al, 2014a ). However, Morishita et al ( 2015a ) reported an unsuccessful case of unilateral VC/VS stimulation. Currently, a bilateral VC/VS DBS study is underway (clinicalTrial.gov Identifier: NCT01072656).…”

Deep Brain Stimulation for the Treatment of Dejerine-Roussy Syndrome

“…They did note, however, that patients experienced improvement in the affective component of their pain. An additional patient implanted with VC/VS and ventral oralis electrodes did not achieve satisfactory pain relief [72]. Although stimulation of the VC/VS may be a prospective treatment option, there is not enough data to warrant its current use in clinical practice.…”