Cerebellar-subcortical circuits and mania in cerebellar disease.

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Back to table of contents Previous article Next article LetterFull AccessCerebellar–Subcortical Circuits and Mania in Cerebellar DiseaseEdward C. Lauterbach, M.D., Edward C. LauterbachSearch for more papers by this author, M.D., Department of Psychiatry and Behavioral Sciences, Mercer University School of Medicine, Macon, GAPublished Online:1 Feb 2001https://doi.org/10.1176/jnp.13.1.112AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail SIR: Recently Rapoport and colleagues1 selectively reviewed the role of the cerebellum in cognition and behavior. Although cerebellar relationships with the cerebral cortex via the thalamus were cited, I wish to add to the discussion by calling attention to cerebellar connections to subcortical structures of significance in neuropsychiatric disorders.Whereas the hippocampus and fornix project to the cerebellum, the cerebellum projects to the septum, amygdala, hippocampus, locus ceruleus, ventral tegmental area, substantia nigra, striatum, globus pallidus, pedunculopontine nucleus, and thalamus (including mediodorsal, intralaminar, and pulvinar nuclei).2 Thus, the cerebellum may exert influence over critical subcortical pathways in neuropsychiatry, including limbic circuits, hippocampus, and temporal lobe connections, monoamine projections, and basal ganglia–thalamocortical circuits influencing temporal and prefrontal cortex.Furthermore, these connections appear to have functional significance. Cerebellolimbic discharges are observed in primate manic-like aggression (Harlow and Harlow 1962;2 Dow et al. 19742), human mood has been influenced by cerebellar stimulation (Cooper et al. 19742), cerebellar lesions affect contralateral basal ganglia and bilateral frontal blood flow (Rousseaux and Steinling 19922), and dentatothalamoprefrontal circuits are thought to mediate the frontal readiness potential (Shibasaki et al. 19782). The potential importance of cerebellar connections with these subcortical structures is therefore worth further consideration.Although study of the cerebellum in primary bipolar disorders has not as yet led to clear findings, the study of secondary bipolar disorders after isolated lesions may provide supplemental evidence for cerebellar relevance in mood disorders. We have described 3 bipolar cases associated with cerebellar hypoplasia, cerebellar atrophy (associated with rapid-cycling bipolar disorder), and a dentatorubrothalamic tract lesion (associated with mixed-type bipolar disorder) among 15 patients screened for isolated cerebellar lesions. This 20% rate was significantly greater than normative population rates (P<0.005) and rates in control subjects with isolated focal subcortical cerebral hemispheric lesions (P<0.05), perhaps suggesting an important effect of cerebellar lesions in relation to mania. Moreover, there have been a number of other reports describing manic features in the context of cerebellar pathology (Cutting 1976;2 Hamilton et al. 1983;2 Yadalam et al. 1985;2 Endo 19862). Kalayam et al.3 have reported 3 cases of SCID-diagnosed DSM-III-R mania associated with acoustic neuromas. The cerebellum was retracted and manipulated in 2 of these cases, and the other case was associated with cerebellar atrophy.Taken together, these findings provide additional preliminary evidence of association between cerebellar lesions and the development of mania. It is possible that cerebellosubcortical circuits are involved in mediating mood disturbances.References1 Rapoport M, van Reekum R, Mayberg H: The role of the cerebellum in cognition and behavior: a selective review. J Neuropsychiatry Clin Neurosci 2000; 12:193–198Link, Google Scholar2 Lauterbach EC: Bipolar disorders, dystonia, and compulsion after dysfunction of the cerebellum, dentatorubrothalamic tract, and substantia nigra. Biol Psychiatry 1995; 40:726–730Crossref, Google Scholar3 Kalayam B, Young RC, Tsuboyama GK: Mood disorders associated with acoustic neuromas. Int J Psychiatry Med 1994; 24:31–43Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByBipolar Disorders, Vol. 18, No. 3Psychiatric Manifestations Associated With Mega Cisterna MagnaSwapna Pandurangi, M.B.B.S., Aditya Pandurangi, M.D., Abhay Matkar, M.D., Nithin Shetty, M.B.B.S., and Preetam Patil, M.D.1 April 2014 | The Journal of Neuropsychiatry and Clinical Neurosciences, Vol. 26, No. 2 Volume 13Issue 1 February 2001Pages 112-112 Metrics PDF download History Published online 1 February 2001 Published in print 1 February 2001