Behavioural disorders, Parkinson's disease and subthalamic stimulation

Abstract

Objective: to analyse 24 parkinsonian patients successfully treated by bilateral STN stimulation for the presence of behavioural disorders. Method: patients were evaluated retrospectively for adjustment disorders (social adjustment scale, SAS), psychiatric disorders (comparison of the results of psychiatric interview and the mini international neuropsychiatric inventory) and personality changes (IOWA scale of personality changes). Results: parkinsonian motor disability was improved by 69.5% and the levodopa equivalent daily dosage was reduced by 60.5%. Social adjustment (SAS) was considered good or excellent in nine patients, moderately (n=14), or severely (n=1) impaired in 15 patients. Psychiatric disorders consisted of amplification or decompensation of previously existing disorders that had sometimes passed unnoticed, such as depressive episodes (n=4), generalised anxiety (n=18), and behavioural disorders with drug dependence (n=2). Appearance of mild to moderate emotional hyperreactivity was reported in 15 patients. Personality traits (IOWA scale) were improved in eight patients, unchanged in seven, and aggravated in eight Conclusion: Improvement in parkinsonian motor disability induced by STN stimulation is not necessarily accompanied by improvement in psychic function and quality of life. Attention is drawn to the possible appearance of personality disorders and decompensation of previous psychiatric disorders in parkinsonian patients who are suitable candidates for neurosurgery. We suggest that a careful psychological and psychiatric interview be performed before surgery, and emphasise the need for psychological follow up to ensure the best possible outcome. Bilateral continuous high frequency stimulation of the subthalamic nucleus (STN) was recently introduced to treat advanced forms of Parkinson's disease. 1 The method currently used improves motor disability by 33%-67%, motor fluctuations by 73%-83%, and levodopa induced dyskinesias by 55%-88%, and permits a 40%-80% reduction in the doses of antiparkinsonian medication, compared with the preoperative state. 2-6Several factors contribute to the efficacy of the treatment: the stringency of the inclusion criteria, the accuracy of electrode implantation in the STN, and long term optimisation of the stimulation parameters. 5 The surgical intervention has little or no effect on cognitive function. Two recent studies showed that chronic bilateral subthalamic stimulation affects neither memory nor executive functions. 7 8 A third study, however, showed that frontal lobe-like symptomatology can be aggravated in patients 70 years of age or older. 9 The question of behavioural effects of the treatment has not yet been addressed directly, except in a few isolated case reports. 9 We report the results of a retrospective study designed to explore the range of behavioural disorders in 24 patients successfully treated by bilateral STN stimulation.

Subthalamic Nucleus Lesions Enhance the Psychomotor-Activating, Incentive Motivational, and Neurobiological Effects of Cocaine

“…For example, Baunez and colleagues reported that bilateral STN lesions enhance motivation for food, as measured by progressive ratio performance and conditioned place preference (Baunez et al, 2002(Baunez et al, , 2005. Furthermore, HFS of the STN, which is thought to mimic ablation of the STN by inducing depolarization block (Benazzouz et al, 1993(Benazzouz et al, , 1995(Benazzouz et al, , 2000Lozano et al, 2002) (but see Garcia et al, 2005), enhances motivation and decreases apathy and also increases the therapeutic potency of the dopamine-enhancing drug L-3,4-dihydroxyphenylalanine (L-DOPA) in patients with Parkinson's disease (Limousin et al, 1998;Houeto et al, 2002;Funkiewiez et al, 2003;Ashkan et al, 2004).…”

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

“…Eleven of them 3,22,36,52,61,67,69,70,73,76,78 presented data in a non-comparable way, with a total of 52 references allowing quantitative analysis.…”

Dianas quirúrgicas en el tratamiento de enfermedades psiquiátricas. Desde el movimiento a las emociones

“…Otros autores, por el contrario, han referido la aparición de ICD en pacientes tratados con DBS a pesar de la reducción de agonistas DA 49,72,104 . Por último en otros estudios realizados, la estimulación del núcleo subtalámico en pacientes jóvenes, aumentaría el riesgo de desarrollar ICD y en este contexto, no únicamente existiría un incremento en presentar un cuadro de impulsividad, sino también un mayor riesgo de suicidio 12,55,98,103,104,119 .…”