Skip to main content

Advertisement

SpringerLink
Log in

Behavioral changes associated with deep brain stimulation surgery for Parkinson’s disease

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Evaluation for psychiatric and cognitive dysfunction is a crucial part of preoperative assessment for deep brain stimulation (DBS) surgery. All candidates for DBS should be treated for active psychiatric disorders, and the treatment team should also screen for past psychiatric history, which may predispose to postoperative psychiatric illness. A wide range of behavioral symptoms have been seen following DBS, including depression, hallucinations or true psychosis, mania, and impulsivity. Suicidal ideation should be treated aggressively. Cognitive changes may occur, but data are currently too limited to make predictions regarding subtle effects on cognition. However, patients with dementia may experience further decline in cognitive function following DBS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Aarsland D, Larsen JP, Lim NG, et al.: Range of neuropsychiatric disturbances in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1999, 67:492–496.

    PubMed  CAS  Google Scholar 

  2. Marder K, Jacobs DM: Dementia. In Parkinson’s Disease: Diagnosis and Clinical Management. Edited by Factor SA, Weiner JW. New York: Demos; 2001:125–135.

    Google Scholar 

  3. Mega MS, Cummings JL: Frontal-subcortical circuits and neuropsychiatric disorders. J Neuropsychiatry Clin Neurosci 1994, 6:358–370.

    PubMed  CAS  Google Scholar 

  4. Loher TJ, Burgunder JM, Pohle T, et al.: Long-term pallidal deep brain stimulation in patients with advanced Parkinson disease: 1-year follow-up study. J Neurosurg 2002, 96:844–853.

    Article  PubMed  Google Scholar 

  5. Martinez-Martin P, Valldeoriola F, Tolosa E, et al.: Bilateral subthalamic nucleus stimulation and quality of life in advanced Parkinson’s disease. Mov Disord 2002, 17:372–377.

    Article  PubMed  Google Scholar 

  6. Scott B, Borgman A, Engler H, et al.: Gender differences in Parkinson’s disease symptom profile. Acta Neurol Scand 2000, 102:37–43.

    Article  PubMed  CAS  Google Scholar 

  7. Schrag A, Jahanshahi M, Quinn NP: What contributes to depression in Parkinson’s disease? Psychol Med 2001, 31:65–73.

    Article  PubMed  CAS  Google Scholar 

  8. Berney A, Vingerhoets F, Perrin A, et al.: Effect on mood of subthalamic DBS for Parkinson’s disease: a consecutive series of 24 patients. Neurology 2002, 59:1427–1429.Although a third of those who developed depression had a prior history of affective disorder, other patients with a history of mood disorder did not develop postoperative depression. Half of the patients who developed depression were transiently suicidal; all required treatment. These results suggest that mood symptoms seen postoperatively should be treated aggressively.

    PubMed  CAS  Google Scholar 

  9. Doshi PK, Chhaya N, Bhatt MH: Depression leading to attempted suicide after bilateral subthalamic nucleus stimulation for Parkinson’s disease. Mov Disord 2002, 17:1084–1085.

    Article  PubMed  Google Scholar 

  10. Houeto JL, Mesnage V, Mallet L, et al.: Behavioural disorders, Parkinson’s disease and subthalamic stimulation. J Neurol Neurosurg Psychiatry 2002, 72:701–707.In this series of 24 deep brain stimulation cases, anxiety symptoms were seen in 75% of patients postoperatively. They also found that many patients developed generalized anxiety disorder, but also had particular concerns about sudden stimulator failure. Depression developed in five patients, four of whom had prior history of depressive symptoms. However, other patients with past history of depression did not develop mood symptoms postoperatively, making risk for depression difficult to predict.

    Article  PubMed  CAS  Google Scholar 

  11. Thobois S, Mertens P, Guenot M, et al.: Subthalamic nucleus stimulation in Parkinson’s disease: clinical evaluation of 18 patients. J Neurol 2002, 249:529–534.

    Article  PubMed  CAS  Google Scholar 

  12. Bejjani BP, Damier P, Arnulf I, et al.: Transient acute depression induced by high-frequency deep-brain stimulation. N Engl J Med 1999, 340:1476–1480.

    Article  PubMed  CAS  Google Scholar 

  13. Moro E, Scerrati M, Romito LM, et al.: Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinson’s disease. Neurology 1999, 53:85–90.

    PubMed  CAS  Google Scholar 

  14. Woods SP, Fields JA, Lyons KE, et al.: Neuropsychological and quality of life changes following unilateral thalamic deep brain stimulation in Parkinson’s disease: a one-year followup. Acta Neurochir (Wien) 2001, 143:1273–1277.

    Article  CAS  Google Scholar 

  15. Ardouin C, Pillon B, Peiffer E, et al.: Bilateral subthalamic or pallidal stimulation for Parkinson’s disease affects neither memory nor executive functions: a consecutive series of 62 patients. Ann Neurol 1999, 46:217–223.

    Article  PubMed  CAS  Google Scholar 

  16. Burchiel KJ, Anderson VC, Favre J, Hammerstad JP: Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson’s disease: results of a randomized, blinded pilot study. Neurosurgery 1999, 45:1375–1382.

    Article  PubMed  CAS  Google Scholar 

  17. Groenewegen HJ, Berendse HW: Connections of the subthalamic nucleus with ventral striatopallidal parts of the basal ganglia in the rat. J Comp Neurol 1990, 294:607–622.

    Article  PubMed  CAS  Google Scholar 

  18. Rodriguez-Oroz MC, Rodriguez M, Curidi J, et al.: The subthalamic nucleus in Parkinson’s disease: somatotopic organization and physiological characteristics. Brain 2001, 124:1777–1790.

    Article  PubMed  CAS  Google Scholar 

  19. Ceballos-Baumann AO, Boecker H, Bartenstein P, et al.: A positron emission tomographic study of subthalamic nucleus stimulation in Parkinson disease: enhanced movement-related activity of motor-association cortex and decreased motor cortex resting activity. Arch Neurol 1999, 56:997–1003.

    Article  PubMed  CAS  Google Scholar 

  20. Potter WZ, Rudorfer MV, Manji H: The pharmacologic treatment of depression. N Engl J Med 1991, 325:633–642.

    Article  PubMed  CAS  Google Scholar 

  21. Dinsky IA, Jouandet ML, Goldman-Rakic PS: Organization of the nigrothalamocortical system in the rhesus monkey. J Comp Neurol 1985, 236:315–330.

    Article  Google Scholar 

  22. Goldman-Rakic PS, Porrino LJ: The primate mediodorsal (MD) nucleus and its projection to the frontal lobe. J Comp Neurol 1985, 242:535–560.

    Article  PubMed  CAS  Google Scholar 

  23. Giovannoni G, O’Sullivan JD, Turner K, et al.: Hedonistic homeostatic dysregulation in patients with Parkinson’s disease on dopamine replacement therapies. J Neurol Neurosurg Psychiatry 2000, 68:423–428.

    Article  PubMed  CAS  Google Scholar 

  24. Kulisevsky J, Berthier ML, Gironell A, et al.: Mania following deep brain stimulation for Parkinson’s disease. Neurology 2002, 59:1421–1424.

    PubMed  CAS  Google Scholar 

  25. Miyawaki E, Perlmutter JS, Troster AI, et al.: The behavioral complications of pallidal stimulation: a case report. Brain Cogn 2000, 42:417–434.

    Article  PubMed  CAS  Google Scholar 

  26. Kumar K, Kelly M, Toth C: Deep brain stimulation of the ventral intermediate nucleus of the thalamus for control of tremors in Parkinson’s disease and essential tremor. Stereotact Funct Neurosurg 1999, 72:47–61.

    Article  PubMed  CAS  Google Scholar 

  27. Richard IH, Schiffer RB, Kurlan R: Anxiety and Parkinson’s disease. J Neuropsychiatry Clin Neurosci 1996, 8:383–392.

    PubMed  CAS  Google Scholar 

  28. Alegret M, Junque C, Valldeoriola F, et al.: Effects of bilateral subthalamic stimulation on cognitive function in Parkinson disease. Arch Neurol 2001, 58:1223–1227.Pre- and postoperative neuropsychologic evaluation of 15 patients who underwent implantation for subthalamic nucleus deep brain stimulation (STN-DBS). Although some deterioration was seen in verbal memory, executive, and visuospatial functions on formal testing, the authors concluded that STN-DBS improved motor symptoms in Parkinson’s disease without clinically relevant neuropsychologic decline.

    Article  PubMed  CAS  Google Scholar 

  29. Diederich NJ, Alesch F, Goetz CG: Visual hallucinations induced by deep brain stimulation in Parkinson’s disease. Clin Neuropharmacol 2000, 23:287–289.

    Article  PubMed  CAS  Google Scholar 

  30. Iranzo A, Valldeoriola F, Santamaria J, et al.: Sleep symptoms and polysomnographic architecture in advanced Parkinson’s disease after chronic bilateral subthalamic stimulation. J Neurol Neurosurg Psychiatry 2002, 72:661–664.Studied changes in sleep quality in 11 Parkinson’s disease patients following deep brain stimulation surgery. Sleep quality improved subjectively in the majority of patients. Polysomnographic studies also demonstrated an increase in uninterrupted sleep and a decrease in the arousal index. Benefits of this procedure on sleep were attributed to positive effects on nocturnal mobility and decrease of sleep fragmentation.

    Article  PubMed  CAS  Google Scholar 

  31. Shulman LM, Taback RL, Bean J, Weiner WJ: Comorbidity of the nonmotor symptoms of Parkinson’s disease. Mov Disord 2001, 16:507–510.

    Article  PubMed  CAS  Google Scholar 

  32. Foncke E, van der LC, Vandewalle V, et al.: Chronic bilateral stimulation of the subthalamic nucleus (STN) in 15 patients with advanced ideopathic Parkinson’s disease previously treated with unilateral internal globus pallidus (GPi) stimulation. Neurology 2001, 56(suppl 3):A272.

    Google Scholar 

  33. Hariz MI, Johansson F, Shamsgovara P: Bilateral subthalamic nucleus stimulation in a Parkinsonian patient with preoperative deficits in speech and cognition: persisting improvement in mobility but increased dependency. A case study. Mov Disord 2000, 15:136–139.

    Article  PubMed  CAS  Google Scholar 

  34. Limousin P, Krack P, Pollak P, et al.: Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 1998, 339:1105–1111.

    Article  PubMed  CAS  Google Scholar 

  35. Saint-Cyr JA, Trepanier LL, Kumar R, et al.: Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson’s disease. Brain 2000, 123)(Pt 10):2091–2108. Before and after study of 11 Parkinson’s disease patients with subthalamic nucleus deep brain stimulation. Mild cognitive declines were found 12 months later in working memory, speed of mental processing, encoding of visuospatial material, phonemic fluency, long-term consolidation of verbal material, and set switching. Patients older than 69 years of age showed more consistent declines. These results suggest that older patients should receive careful evaluation for memory deficits prior to surgery, because they are at greater risk of postoperative cognitive compromise.

    Article  PubMed  Google Scholar 

  36. Fields JA, Troster AI: Cognitive outcomes after deep brain stimulation for Parkinson’s disease: a review of initial studies and recommendations for future research. Brain Cogn 2000, 42:268–293.

    Article  PubMed  CAS  Google Scholar 

  37. Lezak MD: Neuropsychological Assessment, edn 3. Oxford: Oxford University Press; 1995.

    Google Scholar 

  38. Jahanshahi M, Ardouin CM, Brown RG, et al.: The impact of deep brain stimulation on executive function in Parkinson’s disease. Brain 2000, 123(Pt 6):1142–1154.

    Article  PubMed  Google Scholar 

  39. Perozzo P, Rizzone M, Bergamasco B, et al.: Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: comparison of pre- and postoperative neuropsychological evaluation. J Neurol Sci 2001, 192:9–15.

    Article  PubMed  CAS  Google Scholar 

  40. Pillon B, Ardouin C, Damier P, et al.: Neuropsychological changes between "off" and "on" STN or GPi stimulation in Parkinson’s disease. Neurology 2000, 55:411–418.Before and after study of 62 Parkinson’s disease patients with either subthalamic nucleus or globus pallidum internus deep brain stimulation (DBS). The authors found that DBS did not significantly affect the patients’ cognitive performance 12 months after surgery other than a mild but significant deficit in lexical fluency.

    PubMed  CAS  Google Scholar 

  41. Trepanier LL, Kumar R, Lozano AM, et al.: Neuropsychological outcome of GPi pallidotomy and GPi or STN deep brain stimulation in Parkinson’s disease. Brain Cogn 2000, 42:324–347.

    Article  PubMed  CAS  Google Scholar 

  42. Van Horn G, Schiess MC, Soukup VM: Subthalamic deep brain stimulation: neurobehavioral concerns. Arch Neurol 2001, 58:1205–1206.

    Article  PubMed  Google Scholar 

  43. Molinuevo JL, Valldeoriola F, Tolosa E, et al.: Levodopa withdrawal after bilateral subthalamic nucleus stimulation in advanced Parkinson disease. Arch Neurol 2000, 57:983–988.

    Article  PubMed  CAS  Google Scholar 

  44. Volkmann J, Allert N, Voges J, et al.: Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD. Neurology 2001, 56:548–551.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Movement Disorders, Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street, Room NW49A, 21201, Baltimore, MD, USA

    Karen E. Anderson MD & Jake Mullins BA

Authors
  1. Karen E. Anderson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jake Mullins BA
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Anderson, K.E., Mullins, J. Behavioral changes associated with deep brain stimulation surgery for Parkinson’s disease. Curr Neurol Neurosci Rep 3, 306–313 (2003). https://doi.org/10.1007/s11910-003-0007-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-003-0007-z

Keywords

Search

Navigation