Psychiatric and Behavioral Complications of GPi DBS inan Adolescent with Myoclonus Dystonia

Myoclonus dystonia is a rare movement disorder that often causes significant disability. Deep brain stimulation of the internalpallidum (GPi DBS) is a recommended treatment for those who do not respond to pharmacotherapy or who have intolerableside effects. This paper reports on the case of a 17-year-old male who was admitted to a tertiary level mental healthcare facilityfor treatment of psychiatric and behavioral symptoms thought to be related to GPi DBS. Prior to GPi DBS insertion, the patientwas diagnosed with anxiety and mild obsessive compulsive disorder (OCD). Following insertion, his OCD became severe andhe developed depression, Tourette syndrome, and stuttering. His first admission to a psychiatric unit was for management of amanic episode following treatment for depression with fluoxetine, and he began to exhibit severe aggressive behavior. GPi DBS wasturned off, but there were neither changes in dystonic movements nor improvement in aggressive behavior or psychiatric symptoms,though stuttering improved. The patient was transferred to a secure treatment centre where he was able to gain control over hisbehaviors with intense dialectical behavior therapy, but the aggressive behavior and safety concerns continue to persist today.