Dear listmembers,
I would like to react briefly on the concern
regarding the mental change after STN surgery.
I am just summarizing in short the findings
of 99 patients I am involved with who had STN surgery under my
supervision.
Most older patients (16 patients > 70 yrs) had
temporary confusional episodes immediately after surgery lasting for up to 24
hours.
Two patients, who had some minimal evidence
of dementia before surgery further deteriorated after surgery and now
need continuous medical assistance, but their motor problems continue to be much
better after surgery.
4 older patients have become demented. Although
they did not show evidence of dementia, they experienced some episodic
confusional states before surgery.
4 male patients developed
hypersexuality.
1 female and 6 male patients became
hypomanic.
7 patients have mild depression.
2 patients have delusions.
Most patients, who had hallucinations before
surgery due to chronic anti-Parkinson medication, stopped having
hallucinations.
Despite dramatic motor improvements, 2 patients committed suicide.
Thus, out of 99 patients, 23 patients had some kind
of persistent mental change, but in almost all patients there was a significant
reduction of motor problems.
How to avoid post-op problems:
Strict selection criteria.
A normal MMSE dementia test with a score 26 or
higher (from a scale 0 - 30)
Only subtle changes on neurpsychological
testing.
Consider older age (over 70) as a risk factor,
however, not for lack of motor response.
Confusional states before surgery may be a risk
factor.
A thorough psychiatric evaluation is
mandatory.
For all of you off course a happy and above all
healthy 2001.
Chris van der Linden, M.D.
Movement Disorder Center
St. Lucas Hospital Ghent
Belgium