Pathological Crying Caused by High-frequency Stimulation in the Region of the Caudal Internal Capsule

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.