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Behavioural disorders, Parkinson's disease and subthalamic stimulation
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  1. J L Houeto1,
  2. V Mesnage1,
  3. L Mallet6,
  4. B Pillon2,
  5. M Gargiulo1,
  6. S Tezenas du Moncel7,
  7. A M Bonnet1,
  8. B Pidoux3,
  9. D Dormont4,
  10. P Cornu5,
  11. Y Agid1
  1. 1Centre d'Investigation Clinique, Fédération de Neurologie and INSERM U 289, France
  2. 2INSERM E 007, France
  3. 3Fédération de Neurophysiologie Clinique, Hôpital de la Salpêtriére, Paris, France
  4. 4Services de Neuroradiologie, Hôpital de la Salpêtriére, Paris, France
  5. 5Services de Neurochirurgie, Hôpital de la Salpêtriére, Paris, France
  6. 6Services de Psychiatrie, Hôpital de la Salpêtriére, Paris, France
  7. 7Services de Informatique Médicale, Hôpital de la Salpêtriére, Paris, France
  1. Correspondence to:
 Dr Y Agid, Centre d'Investigation Clinique, Hôpital de la Salpêtriére, 47 Boulevard de l'Hôpital, 75013 Paris, France;
 agid{at}ccr.jussieu.fr

Abstract

Objective: to analyse 24 parkinsonian patients successfully treated by bilateral STN stimulation for the presence of behavioural disorders.

Method: patients were evaluated retrospectively for adjustment disorders (social adjustment scale, SAS), psychiatric disorders (comparison of the results of psychiatric interview and the mini international neuropsychiatric inventory) and personality changes (IOWA scale of personality changes).

Results: parkinsonian motor disability was improved by 69.5% and the levodopa equivalent daily dosage was reduced by 60.5%. Social adjustment (SAS) was considered good or excellent in nine patients, moderately (n=14), or severely (n=1) impaired in 15 patients. Psychiatric disorders consisted of amplification or decompensation of previously existing disorders that had sometimes passed unnoticed, such as depressive episodes (n=4), generalised anxiety (n=18), and behavioural disorders with drug dependence (n=2). Appearance of mild to moderate emotional hyperreactivity was reported in 15 patients. Personality traits (IOWA scale) were improved in eight patients, unchanged in seven, and aggravated in eight

Conclusion: Improvement in parkinsonian motor disability induced by STN stimulation is not necessarily accompanied by improvement in psychic function and quality of life. Attention is drawn to the possible appearance of personality disorders and decompensation of previous psychiatric disorders in parkinsonian patients who are suitable candidates for neurosurgery. We suggest that a careful psychological and psychiatric interview be performed before surgery, and emphasise the need for psychological follow up to ensure the best possible outcome.

  • Parkinson's disease
  • high frequency stimulation
  • subthalamic nucleus
  • behavioural disorders
  • psychiatry
  • STN, subthalamic nucleus
  • SAS, social adjustment scale
  • UPDRS, unified Parkinson's disease rating scale
  • MINI, mini international neuropsychiatric inventory
  • ISPC, IOWA scales of personality change

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