J Neuropsychiatry Clin Neurosci 16:1, Winter 200437
Right Pallidotomy for
Mario F. Mendez, M.D., Ph.D.
Susan M. O’Connor, M.D.
Gerald T.H. Lim, M.D.
Received April 16, 2002; revised September 13, 2002; accepted Oc-
tober 1, 2002. From the Departments of Neurology and Psychiatry
and Biobehavioral Sciences, University of California at Los Angeles,
Los Angeles, California. Address correspondence to Dr. Mendez,
Neurobehavior Unit (116AF), VA Greater L.A. Healthcare System,
11301 Wilshire Blvd., Los Angeles, CA 90073; mmendez@UCLA.edu
Copyright ? 2004 American Psychiatric Publishing, Inc.
The authors describe hypersexuality following
atypical right pallidotomy for intractable Parkin-
son’s disease (PD). This patient and literature re-
view suggest important roles for the pallidum in
sexual behavior and dopamine in sexual arousal.
(The Journal of Neuropsychiatry and Clinical
Neurosciences 2004; 16:37–40)
tient with profound changes in sexuality after pallido-
tomy surgery for PD and review the literature on pos-
sible neurological mechanisms for hypersexuality.
atients with Parkinson’s disease (PD) may develop
levodopa-induced hypersexuality.1We report a pa-
A 59-year-old, right-handed man underwent a right pal-
lidotomy for PD of 16 years duration. Prior to surgery,
he had left-sided rigidity and bradykinesia, left upper
extremity tremor, posturalinstability,bradyphrenia,and
hypophonia. He had moderate disability and remained
independent in activities of daily living, but he could no
longer work as an engineer. After the pallidotomy, his
left-sided symptoms significantly improved. His past
medical history included hypertension and a remote
closed head injury. There was no history of psychiatric
illness, unusual sexual behavior, or drug-induced be-
havioral changes prior to his surgery.
Immediately after the pallidotomy, the patient began
demanding oral sex up to 12 to 13 times a day from his
wife of 41 years. He forced her to have sex with him
despite her serious cardiac condition. He masturbated