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Hu Liang Low, MSc, FRCS(SN); Faisal T. Sayer, MD, MSc; Christopher R. Honey, MD, DPhil, FRCS(C)

Arch Neurol. 2008;65(2):264-266.

Background  Pathological crying has been rarely reported after deep brain stimulation. The exact neural substrate is unknown, but it is often assumed that pathological crying and the pseudobulbar syndrome result from disturbances of a common neural pathway.

Design  Case report.

Setting  Tertiary referral center for neurosurgery.

Patient  A 48-year-old woman with advanced Parkinson disease who received bilateral implantation of deep brain stimulators in her subthalamic nuclei.

Results  Stimulation in the region of the caudal internal capsule resulted in pathological crying but no other features of pseudobulbar palsy.

Conclusions  At least 1 of the pathways controlling crying passes through the region of the caudal internal capsule, and this pathway is distinct from those involved with laughter and nonemotional facial movements. Moreover, different stimulation frequencies may elicit either crying or anxiety but not both.

Author Affiliations: Department of Neurosurgery, University Hospital of Wales, Cardiff, Wales (Dr Low); and Surgical Centre for Movement Disorders, University of British Columbia, Vancouver, British Columbia, Canada (Drs Low, Sayer, and Honey).