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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 58, Num. 3, 2010, pp. 503-503

Neurology India, Vol. 58, No. 3, May-June, 2010, pp. 503


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

25 bis rue des Envierges, 75020 Paris, France
Correspondence Address: Christian Saleh, 25 bis rue des Envierges, 75020 Paris, France,

Date of Acceptance: 17-Jun-2010

Code Number: ni10134

PMID: 20644300
DOI: 10.4103/0028-3886.65536


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.


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]  

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