Mania following deep brain stimulation for Parkinson’s disease

Abstract

Three patients with PD developed manic behavior after bilateral implantation of electrodes for deep-brain stimulation (DBS). Common to all three patients were manic symptoms unremitting after levodopa reduction or stimulation "off," lower electrodes positioning caudal to the subthalamic nucleus area, postoperative DBS with the lower contacts (0) of the quadripolar electrodes, and resolution of the manic episodes coinciding with stimulation through higher contacts.

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

“…Mood problems are more common in patients treated with STN-DBS than those treated with GPi-DBS Follett et al, 2010;Moro et al, 2010;Bronstein et al, 2011). Although the underlying substrate of these side effects remains to be characterized, it has been suggested that they may be induced by stimulation in non-motor areas of STN or GPi, inadvertent involvement of limbic structures outside of the target regions (Bejjani et al, 1999;Krack and Vercueil, 2001;Kulisevsky et al, 2002;Romito et al, 2002;Herzog et al, 2003a;Okun et al, 2003;Stefurak et al, 2003), and preexisting psychiatric conditions (Lilleeng and Dietrichs, 2008). Although significant unpleasant mood side effects following STN or GPi DBS are relatively rare (Funkiewiez et al, 2004;Castelli et al, 2006;Tir et al, 2007), their occurrence significantly disrupts patients' quality of life.…”

CBT for the treatment of depression in Parkinson’s disease: a promising nonpharmacological approach

“…In addition to improving motor function, some studies have also found DBS to be associated with improvements in mood and depression [40,41,42]. The results of these studies are equivocal, however, as some reports have demonstrated adverse reactions, including significant worsening of depressive symptoms and suicidal ideation [41,43,44] and inducement of mania [45,46,47]. In addition, a randomized, controlled trial of Qigong exercise showed decreases in depression scores in both the control and treatment group, although those in the treatment group did experience a greater improvement in motor symptoms [48].…”

Postoperative management of deep brain stimulation in Parkinson’s disease

“…In the postoperative phase, a state of mild euphoria and hyperactivity can frequently be observed, but this is generally transient if medication is reduced in tandem . However, an excessively rapid increase in stimulation parameters can also induce hilarity, hypomania, mania, or impulse-control disorders (Krack et al, 2001;Kulisevsky et al, 2002;Romito et al, 2002;Herzog et al, 2003;Mandat et al, 2006;Ulla et al, 2006Ulla et al, , 2011Mallet et al, 2007;Raucher-Chene et al, 2008;Coenen et al, 2009;Chopra et al, 2011) requiring adaptation of medical treatment and/or stimulation settings. These behavioral changes are usually induced by stimulation with the more ventral and medial contacts (i.e., stimulation of the ventral limbic STN) (Krack et al, 2001;Mallet et al, 2007).…”

“…These behavioral changes are usually induced by stimulation with the more ventral and medial contacts (i.e., stimulation of the ventral limbic STN) (Krack et al, 2001;Mallet et al, 2007). Nevertheless the exact postoperative localization of active stimulating contact is difficult to achieve and there is still uncertainty concerning the exact mechanism underlying mania in patients with PD and STN stimulation, with some authors claiming it is related to current diffusion to the medial forebrain bundle and lateral hypothalamus (Coenen et al, 2009), and others to ventrally located regions such as the substantia nigra (Kulisevsky et al, 2002;Ulla et al, 2011). When mania occurs, it may be necessary to change the active contact to a more dorsal one, to reduce dopaminergic medication (especially dopamine agonists), and, in the most severe cases, to use an atypical antipsychotic Kulisevsky et al, 2002;Mallet et al, 2007;RaucherChene et al, 2008).…”