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Modification of emotional states by bilateral stimulation of the subthalamic nucleus in a patient with Parkinson's disease
  1. Peter Boon1,
  2. Brechje Dandachi-FitzGerald1,3,
  3. Annelien Duits1,3,
  4. Yasin Temel2,3,
  5. Veerle Visser-Vandewalle2,3,
  6. Marcel van den Hout4
  1. 1Department of Psychiatry and Psychology, University Medical Centre, Maastricht, The Netherlands
  2. 2Neurosurgery, University Medical Centre, Maastricht, The Netherlands
  3. 3School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
  4. 4Clinical and Health Psychology, Utrecht University, The Netherlands
  1. Correspondence to Brechje Dandachi-FitzGerald, Department of Psychiatry and Psychology, Maastricht University Medical Centre, PO Box 5800, Maastricht 6202 AZ, The Netherlands; b.fitzgerald{at}mondriaan.eu

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Bilateral stimulation of the subthalamic nucleus (STN) is an accepted treatment for advanced Parkinson's disease (PD) refractory to medical therapy.1 Despite motor improvement, postoperative changes in mood and behaviour have been reported.2 Besides a direct influence of STN stimulation, other factors such as changes in medication and maladaptation to motor improvement might be involved. Here we report a PD patient successfully treated with bilateral STN stimulation but showing postoperative gradual worsening of psychological status. By using a single case experiment design (SCED) we tried to find out whether these problems were stimulation-related.

Case

The patient is a 56-year-old woman with a 13-year history of PD. Before surgery, (neuro)psychological evaluation was normal, besides a slight depressive elevation (Beck Depression Inventory (BDI) total score=13 with scores from 10 to 16 indicating mild depression).3 Psychiatric evaluation, however, revealed no psychopathology.

The patient underwent a one-staged bilateral stereotactical implantation of electrodes4 and was discharged with stimulation at pole 1 monopolar, pulse width 90 μs, frequency 130 Hz, 1.5 V right and 1.2 V left. In the 20 months following surgery, stimulation was adjusted up to 3.0 V bilaterally, to optimise motor function.

During follow-up at 3, 6 and 12 months postoperatively, the patient increasingly complained of various psychological symptoms including depression, …

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