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Psychiatric Side-Effects of Bilateral Deep Brain Stimulation for Movement Disorders

  • Marcus PinskerEmail author
  • Florian Amtage
  • Mathias Berger
  • Guido Nikkhah
  • Ludger Tebartz van Elst
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 117)

Abstract

Introduction: The effects of deep brain stimulation (DBS) on cognitive functions, and its psychiatric side-effects, are still controversial. The present study investigated psychiatric comorbidity and postoperative effects of DBS of different targets on mood and psychological functions in 81 patients with a mean follow-up of 37 months.

Methods: A total of 109 patients underwent implantation of DBS electrodes between 2001 and 2006; it was possible to evaluate 81 patients by a psychiatric test battery using the “Neuropsychiatric Inventory”. To evaluate the possible influence of the target, we analyzed the data without 16 patients with DBS surgery for other diseases (e.g., epilepsia, cluster headache) or unilateral implantation only. The resulting population (n = 65, mean age 61 years, range 23–78 years, male:female 42:23) consisted of 43 Parkinson’s disease patients stimulated in the subthalamic nucleus, ten dystonia patients stimulated in the globus pallidus internus, and 12 tremor patients in the ventral intermediate nucleus.

Results: There was a high rate of preoperative psychiatric comorbidity, which is reflected by a high rate of patients with preoperative medication of neuroleptic drugs (18.4 %, especially clozapin 14.7 %) and antidepressive drugs (16.5 %). Depression was the most common psychiatric side-effect after DBS, occurring in 47.7 % of all patients (31/65 patients), without significant preference to a specific target (STN: 42 %, Gpi: 60 %, VIM: 58 %). Delusion (n = 5 out of 43 PD patients, 11.6 %), euphoria (n = 1, 2.3 %) and disinhibition (n = 3, 7.0 %) were seen in the PD patients only.

Conclusion: A wide range of behavioural changes may be seen following DBS. Depression was the most common side-effect after DBS, and occurred independently of the target. PD patients, in contrast to dystonia and tremor patients, developed complications in all tested subgroups, with varying frequencies. Preoperative evaluation for psychiatric and cognitive dysfunction is crucial to identify patients who are at specific risk for psychiatric complications.

Keywords

Deep brain stimulation Movement disorders Psychiatric side-effects 

Notes

Conflict of Interest

MOP, FA, GN received speaking honoraria from Medtronic.

References

  1. 1.
    Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schafer H, Botzel K, Daniels C, Deutschlander A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Mehdorn HM, Moringlane JR, Oertel W, Pinsker MO, Reichmann H, Reuss A, Schneider GH, Schnitzler A, Steude U, Sturm V, Timmermann L, Tronnier V, Trottenberg T, Wojtecki L, Wolf E, Poewe W, Voges J, German Parkinson Study Group, Neurostimulation Section (2006) A randomized trial for deep brain stimulation in Parkinson’s disease. N Engl J Med 355:896–908PubMedCrossRefGoogle Scholar
  2. 2.
    Weaver FM, Follett K, Stern M, CSP 468 Study Group et al (2009) Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson’s disease: a randomized controlled trial. JAMA 301:63–73PubMedCrossRefGoogle Scholar
  3. 3.
    Kupsch A, Benecke R, Muller J, Trottenberg T, Schneider GH, Poewe W, Eisner W, Wolters A, Muller JU, Deuschl G, Pinsker MO, Skogseid IM, Roeste GK, Vollmer-Haase J, Brentrup A, Krause M, Tronnier V, Schnitzler A, Voges J, Nikkhah G, Vesper J, Naumann M, Volkmann J, Deep-Brain Stimulation for Dystonia Study Group (2006) Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med 355:1978–1990PubMedCrossRefGoogle Scholar
  4. 4.
    Vidailet M, Vercueil L, Hueto JL, Krystkowiak P, Benabid AL, Cornu P, Lagrange C, Tezenas du Montcel S, Dormont D, Grand S, Blond S, Detante O, Pillon B, Ardouin C, Agid Y, Destee A, Pollak P, French Stimulation du Pallidum Interne dans la Dystonie (SPIDY) Study Group (2005) Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia. N Engl J Med 352(5):459–467CrossRefGoogle Scholar
  5. 5.
    Mehdorn HM, Goebel S, Falk D, Volkmann J, Leplow B, Pinsker MO (2008) Deep brain stimulation for movement disorders and its neuropsychological implications. Acta Neurochir 101:9–12CrossRefGoogle Scholar
  6. 6.
    Funkiewiez A, Ardouin C, Caputo E, Krack P, Fraix V, Klinger H, Chabardes S, Foote K, Benabid AL, Pollak P (2004) Long term effects of bilateral subthalamic stimulation on cognitive function, mood, and behaviour in Parkinson’s disease. J Neurol Neurosurg Psychiatry 75:834–839PubMedCrossRefGoogle Scholar
  7. 7.
    Parsons TD, Rogers SA, Braaten AJ, Woods SP, Tröster AI (2006) Cognitive sequelae of subthalamic nucleus deep brain stimulation in Parkinson’s disease: a meta-analysis. Lancet Neurol 5:578–588PubMedCrossRefGoogle Scholar
  8. 8.
    Speelman JD, Smeding HM, Schmannd B (2007) Does chronic subthalamic nucleus stimulation in advanced Parkinson’s disease cause invalidating cognitive and behavioural dysfunctions? J Neurol Neurosurg Psychiatry 78(3):221PubMedCrossRefGoogle Scholar
  9. 9.
    Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J (1994) The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurol 44:2308–2314CrossRefGoogle Scholar
  10. 10.
    Aarsland D, Cummings JL, Larsen JP (2001) Neuropsychiatric differences between Parkinson’s disease with dementia and Alzheimer’s disease. Int J Geriatr Psychiatry 16(2):184–191PubMedCrossRefGoogle Scholar
  11. 11.
    Aarsland D, Brønnick K, Ehrt U, De Deyn PP, Tekin S, Emre M, Cummings JL (2007) Neuropsychiatric symptoms in patients with Parkinson’s disease and dementia: frequency, profile and associated care giver stress. J Neurol Neurosurg Psychiatry 78(1):36–42PubMedCrossRefGoogle Scholar
  12. 12.
    Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, Hall K, Hasegawa K, Hendrie H, Huang Y, Jorm A, Mathers C, Menezes PR, Rimmer E, Scazufca M, and for the Alzheimer’s Disease International (2005) Global prevalence of dementia: a Delphi consensus study. Lancet 366:2112–2117PubMedCrossRefGoogle Scholar
  13. 13.
    Appleby BS, Duggan PS, Regenberg A, Rabins PV (2007) Psychiatric and neuropsychiatric adverse events associated with deep brain stimulation: a meta-analysis often years’ experience. Mov Disord 22(12):1722–1728PubMedCrossRefGoogle Scholar
  14. 14.
    Witt K, Daniels C, Reiff J, Krack P, Volkmann J, Pinsker MO, Krause M, Tronnier V, Kloss M, Schnitzler A, Wojtecki L, Bötzel K, Danek A, Hilker R, Sturm V, Kupsch A, Karner E, Deuschl G (2008) Neuropsychological and psychiatric changes after deep brain stimulation for Parkinson’s disease: a randomised, multicentre study. Lancet Neurol 7:605–614PubMedCrossRefGoogle Scholar
  15. 15.
    Daniels C, Krack P, Volkmann J, Pinsker MO, Krause M, Tronnier V, Kloss M, Schnitzler A, Wojtecki L, Bötzel K, Danek A, Hilker R, Sturm V, Kupsch A, Karner E, Deuschl G, Witt K (2010) Risk factors for executive dysfunction after subthalamic nucleus stimulation in Parkinson’s disease. Mov Disord 25(11):1583–1589PubMedCrossRefGoogle Scholar
  16. 16.
    Von Reichmann H, Deuschl G, Riedel O, Spottke A, Förstl H, Henn F, Heuser I, Oertel W, Riederer P, Trenkwalder C, Dodel R, Wittchen HU (2010) The German study in the epidemiology of Parkinson’s disease with dementia (GEPAD): more than Parkinson. MMW Fortschr Med 152(Suppl 1):1–6Google Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Marcus Pinsker
    • 1
    • 2
    Email author
  • Florian Amtage
    • 3
  • Mathias Berger
    • 4
  • Guido Nikkhah
    • 1
    • 5
  • Ludger Tebartz van Elst
    • 4
  1. 1.Division of Stereotactic and Functional Neurosurgery, Department of General Neurosurgery, Neurosurgical ClinicUniversity Medical Center FreiburgFreiburgGermany
  2. 2.Klinik für NeurochirurgieHELIOS Klinikum Berlin-BuchBerlinGermany
  3. 3.Department of NeurologyUniversity Medical Center FreiburgFreiburgGermany
  4. 4.Department of PsychiatryUniversity Medical Center FreiburgFreiburgGermany
  5. 5.Neurosurgical ClinicUniversity Hospital ErlangenErlangenGermany

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