Neurosurgery in Parkinson disease: a distressed mind in a repaired body?
OBJECTIVE
To prospectively evaluate the impact of subthalamic nucleus (STN) stimulation on social adjustment in patients with Parkinson disease (PD).


METHODS
Before and 18 to 24 months after bilateral STN stimulation, the authors assessed 29 patients with PD for motor disability, cognition (Mattis dementia rating scale, frontal score), psychiatric morbidity (Mini-5.0.0, MADRS, BAS), quality of life (PDQ-39), social adjustment (Social Adjustment Scale), and psychological status using unstructured in-depth interviews.


RESULTS
Despite marked improvement in parkinsonian motor disability, the absence of significant changes in cognitive status, and improvement of activities of daily living and quality of life by the end of the study, social adjustment did not improve. Several kinds of problems with social adjustment were observed, affecting the patients' perception of themselves and their body, marital situation, and professional life. Marital conflicts occurred in 17/24 couples. Only 9 out of 16 patients who had a professional activity before the operation went back to work after surgery.


CONCLUSIONS
After STN stimulation, patients experienced difficulties in their relations with themselves, their spouses, their families, and their socio-professional environment. The authors suggest a multidisciplinary psychosocial preparation and follow-up to help patients and their entourage cope with the sudden changes in their existence following successful neurosurgery.
Schüpbach
M
M
Centre d'Investigation Clinique, Fédération des Maladies du Système Nerveux, INSERM U679, Université Paris VI, CHU Pitié-Salpêtrière, Paris, France.
Gargiulo
M
M
Welter
M L
ML
Mallet
L
L
Béhar
C
C
Houeto
J L
JL
Maltête
D
D
Mesnage
V
V
Agid
Y
Y
D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D046690:Deep Brain Stimulation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012917:Social Adjustment; D020531:Subthalamic Nucleus; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome