Psychiatric considerations in deep brain stimulation for Parkinson’s disease

Voon, Valerie; Howell, Nicholas A.; Krack, Paul

doi:10.1016/b978-0-444-53497-2.00012-7

Cited by 13 publications

(10 citation statements)

References 54 publications

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“…TNM psychiatric manifestations were attributed to the larger reduction of LEDD with STN compared to GPi as all symptoms improved by increasing levodopa and not by changing stimulation parameters [39]. Taken together, these observations suggest that the aggressive medication reduction after STN DBS can lead to levodopa agonist withdrawal which could unmask an underlying mesolimbic hypodopaminergic vulnerability state [40] and manifest as psychiatric symptoms (reviewed in [41, 42]. To test this intriguing concept, Okun et al [43] compared the effect of slow reduction in LEDD on psychiatric side effects following unilateral STN (n=16) and GPi DBS (n=14).…”

Section: Discussionmentioning

confidence: 99%

Stimulation-Induced Transient Nonmotor Psychiatric Symptoms following Subthalamic Deep Brain Stimulation in Patients with Parkinson's Disease: Association with Clinical Outcomes and Neuroanatomical Correlates

Abulseoud

Kasasbeh

Min

et al. 2016

Stereotact Funct Neurosurg

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Background: The clinical and neurobiological underpinnings of transient nonmotor (TNM) psychiatric symptoms during the optimization of stimulation parameters in the course of subthalamic nucleus deep brain stimulation (STN-DBS) remain under intense investigation. Methods: Forty-nine patients with refractory Parkinson's disease underwent bilateral STN-DBS implants and were enrolled in a 24-week prospective, naturalistic follow-up study. Patients who exhibited TNM psychiatric manifestations during DBS parameter optimization were evaluated for potential associations with clinical outcome measures. Results: Twenty-nine TNM+ episodes were reported by 15 patients. No differences between TNM+ and TNM- groups were found in motor outcome. However, unlike the TNM- group, TNM+ patients did not report improvement in subsyndromal depression or quality of life. TNM+ episodes were more likely to emerge during bilateral monopolar stimulation of the medial STN. Conclusions: The occurrence of TNM psychiatric symptoms during optimization of stimulation parameters was associated with the persistence of subsyndromal depression and with lower quality of life ratings at 6 months. The neurobiological underpinnings of TNM symptoms are investigated yet remain difficult to explain.

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Section: Discussionmentioning

confidence: 99%

Stimulation-Induced Transient Nonmotor Psychiatric Symptoms following Subthalamic Deep Brain Stimulation in Patients with Parkinson's Disease: Association with Clinical Outcomes and Neuroanatomical Correlates

Abulseoud

Kasasbeh

Min

et al. 2016

Stereotact Funct Neurosurg

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“…depression, hypomania, and suicide, among others). [12][13][14][15][16] As in most studies on efficacy, those with a blinded design showed no statistically significant differences in the rate of psychiatric complications between targets, 18,9 though there did appear to be trend toward a somewhat higher incidence with STN DBS. To date, the only consensus in the field is that STN DBS increases the postoperative risk of verbal fluency deficits.…”

Section: Is the Stn Or The Gpi The Ideal Target For Dbs In Parkinson'mentioning

confidence: 99%

Deep Brain Stimulation Target Selection for Parkinson’s Disease

Honey

Hamani

Kalia

et al. 2016

Can. J. Neurol. Sci.

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During the "DBS Canada Day" symposium held in Toronto July 4-5, 2014, the scientific committee invited experts to discuss three main questions on target selection for deep brain stimulation (DBS) of patients with Parkinson's disease (PD). First, is the subthalamic nucleus (STN) or the globus pallidus internus (GPi) the ideal target? In summary, both targets are equally effective in improving the motor symptoms of PD. STN allows a greater medications reduction, while GPi exerts a direct antidyskinetic effect. Second, are there further potential targets? Ventral intermediate nucleus DBS has significant long-term benefit for tremor control but insufficiently addresses other motor features of PD. DBS in the posterior subthalamic area also reduces tremor. The pedunculopontine nucleus remains an investigational target. Third, should DBS for PD be performed unilaterally, bilaterally or staged? Unilateral STN DBS can be proposed to asymmetric patients. There is no evidence that a staged bilateral approach reduces the incidence of DBS-related adverse events.RÉSUMÉ: Choix de cible en matière de stimulation cérébrale profonde dans le cas de la maladie de Parkinson. C'est durant le symposium « Stimulation cérébrale profonde (SCP)-Fête du Canada » tenu à Toronto les 4 et 5 juillet 2014 qu'un comité scientifique a invité des experts à aborder trois questions fondamentales en ce qui regarde le choix de cible en matière de SCP dans le cas de patients atteints de la maladie de Parkinson (MP). Premièrement, il leur a été demandé si le noyau sous-thalamique (NST) ou le globus pallidus interne (GPi) constituaient une cible idéale. En résumé, il a été établi que ces deux cibles s'équivalent quant à la capacité d'atténuer les symptômes moteurs de la MP. À ce sujet, si le NST permet une réduction plus importante de la consommation de médicaments, le GPi, lui, exerce un effet anti-dyskinétique direct. Deuxièmement, on a demandé aux experts dans quelle mesure il pouvait y avoir d'autres cibles potentielles. Ainsi, bien que la SCP du noyau ventral intermédiaire procure un avantage important à long terme, elle demeure une avenue insuffisante en ce qui a trait aux autres aspects moteurs de la MP. Soulignons que la SCP de la région sous-thalamique postérieure contribue aussi à réduire les tremblements. Quant au noyau pédonculopontin, il demeure une piste de recherche à explorer. Enfin, est-ce que la SCP devrait être effectuée de façon unilatérale, bilatérale ou être échelonnée en ce qui a trait à des cas de MP ? La SCP unilatérale du NST peut être proposée à des patients dont la symptomatologie est asymétrique. De plus, aucune preuve ne permet de conclure qu'une stimulation bilatérale échelonnée entraîne une réduction de la fréquence des manifestations indésirables liées à la SCP.

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“…Neuropsychiatric symptoms arising after the procedure are mainly transient and treatable . Correct electrode trajectory and placement are crucial factors to avoid these adverse events .…”

Section: Introductionmentioning

confidence: 99%

“…Decrement of dopamine drug dose could explain depression after DBS, which may be transient and responds well to dopaminergic therapy (especially dopamine agonists) and cognitive behavioral therapy . Candidate selection is key to prevent depression …”

Section: Introductionmentioning

confidence: 99%

“…Cognitive decline reported after DBS mainly affects frontal subcortical cognitive functions, such as verbal fluency, processing speed, attention, learning, and working memory . Worse cognitive outcome after surgery remained unmodified regardless of DBS settings or “on” and “off” motor states, suggesting the cause might be related to lead trajectory or location . Predictive factors for cognitive decline after DBS have not been explored in detail, with age and mild cognitive impairment prior to surgery yielding inconclusive results …”

Section: Introductionmentioning

confidence: 99%

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Challenges in PD Patient Management After DBS: A Pragmatic Review

Rossi

Bruno

Arena

et al. 2018

Movement Disord Clin Pract

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Background Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or internal globus pallidus (GPi) represents an effective and universally applied therapy for Parkinson's disease (PD) motor complications. However, certain procedure‐related problems and unrealistic patient expectations may detract specialists from indicating DBS more widely despite significant clinical effects. Methods This review provides a pragmatic educational summary of the most conflicting postoperative management issues in patients undergoing DBS for PD. Results DBS in PD has been associated with certain complications and post‐procedural management issues, which can complicate surgical outcome interpretation. Many PD patients consider DBS outcomes negative due to unfulfilled expectations, even when significant motor symptom improvement is achieved. Speech, gait, postural stability, and cognition may worsen after DBS and body weight may increase. Although DBS may induce impulse control disorders in some cases, in others, it may actually improve them when dopamine agonist dosage is reduced after surgery. However, apathy may also arise, especially when dopaminergic medication tapering is rapid. Gradual loss of response with time suggests disease progression, rather than the wearing off of DBS effects. Furthermore, implantable pulse generator expiration is considered a movement disorder emergency, as it may worsen parkinsonian symptoms or cause life‐threatening akinetic crises due to malignant DBS withdrawal syndrome. Conclusion Major unsolved issues occurring after DBS therapy preclude complete patient satisfaction. Multidisciplinary management at experienced centers, as well as careful and comprehensive delivery of information to patients, should contribute to make DBS outcome expectations more realistic and allow post procedural complications to be better accepted.

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Psychiatric considerations in deep brain stimulation for Parkinson’s disease

Cited by 13 publications

References 54 publications

Stimulation-Induced Transient Nonmotor Psychiatric Symptoms following Subthalamic Deep Brain Stimulation in Patients with Parkinson's Disease: Association with Clinical Outcomes and Neuroanatomical Correlates

Stimulation-Induced Transient Nonmotor Psychiatric Symptoms following Subthalamic Deep Brain Stimulation in Patients with Parkinson's Disease: Association with Clinical Outcomes and Neuroanatomical Correlates

Deep Brain Stimulation Target Selection for Parkinson’s Disease

Challenges in PD Patient Management After DBS: A Pragmatic Review

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