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<---- Begin Forwarded Message ----> From: E-MOVE <[log in to unmask]> To: E-MOVE <[log in to unmask]> Date: Mon, 08 Jul 2002 22:28:05 GMT Subject: Persistence and Emergence of Behavioral Disorders Following Deep Brain Stimulation Behavioral disorders, Parkinson's disease, and subthalamic stimulation JL Houeto, V Mesnage, L Mallet, B Pillon, M Garguilo, S Tezenas du Moncel; AM Bonnet, B Pidoux, D Dormont, P Cornu, Y Agid J Neurol Neurosurg Psychiatry 2002;72:701-707 Deep brain stimulation of the subthalamic nucleus may be accompanied by aggravation of pre-existing behavioral disorders, according to this report. Twenty-four of 28 consecutive PD patients undergoing bilateral DBS surgery agreed to pre-and post-operative interviews and testing regarding social adjustment, neuropsychiatric symptoms, and personality changes. Interviews included retrospective assessment of previous behavioral disorders. Post-surgery mean motor disability improved by 70%, and levodopa dose decreased by 60%. Post-operative global social adjustment was good to excellent in 9 patients, slight to moderately impaired in 14 patients, and severely impaired in 1 patient. Two patients returned to work. Elderly patients had poorer adjustment than younger patients. The authors state that deterioration of conjugal relationships in six patients may have been due to "problems of communication between the patients, who suddenly regained their autonomy, and their devoted spouses, who lost their function after years of more or less permanent disease related compassion and care." Twelve patients had had depressive episodes prior to surgery, and 5 experienced at least one episode afterward, including 1 patient with no prior depression. Among these 12 patients, suicide risk was seen in 3 before surgery, and 4 after. In 2 of 4 patients with agoraphobia, symptoms worsened dramatically after surgery. Seventeen patients had anxiety before surgery, and 18 afterward. Three quarters of patients experienced disabling difficulty in controlling their emotions. Two patients with prior drug dependencies developed signs of levodopa addiction after surgery. One of four patients not included in the study had severe depression in her youth, and committed suicide 9 months after surgery. The authors state, "Although psychiatric disorders were a contraindication, these patients were nevertheless selected for continuous stimulation of the STN. The severity of the history of depression was overlooked when the patients were selected for surgery, probably because the severity of parkinsonian motor disability and levodopa related motor complications predominated over the psychiatric disorders." While no mean change was seen on the IOWA scale of personality change, 8 patients worsened and 8 improved in six characteristics: lack of initiative, perseveration, lack of persistence, lack of planning, apathy, and vulnerability to pressure. The authors conclude, "Patients should undergo a careful psychological and psychiatric interview before surgery to evaluate the sociofamilial environment and the existence of prior personality disorders, addictive behaviour, or depressive episodes. The frequency with which anxiety and emotional hyperreactivity were found after surgery, and the possibility that unnoticed behavioural disorders might become decompensated, points to the need for an appropriate psychological follow up to ensure a favourable outcome." <---- End Forwarded Message ----> ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn