title: Subthalamic stimulation in Parkinson disease: behavior and social adaptation.
abstract: BACKGROUND
  Bilateral subthalamic high-frequency stimulation significantly improves motor functions in patients with advanced forms of Parkinson disease (PD). This favorable effect contrasts with a growing number of reports that the treatment may result in psychiatric complications.
  
  
  OBJECTIVE
  To analyze the presence of behavioral disorders and social maladjustment in PD patients successfully treated with continuous bilateral subthalamic stimulation.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Twenty PD patients underwent prospective evaluation for behavioral and personality changes, quality of life, and social functioning, 6 and 24 months after surgery to implant bilateral stimulating electrodes within the subthalamic nucleus.
  
  
  RESULTS
  At 6 and 24 months after surgery, parkinsonian motor disability (on-stimulation/off-medication) was improved by 81% and 67%, respectively, and the severity of levodopa-related motor complications was improved by 84% and 70%, respectively. Levodopa-equivalent dosage was decreased by 79% and 66%, respectively; severity of depression was improved by 21% and 33%, respectively; and severity of anxiety was improved by 43% and 64%, respectively. The patients' personality traits were unmodified. Twenty-four months after surgery, the global score for quality of life was improved by 28%, whereas scores for social adjustment remained stable.
  
  
  CONCLUSIONS
  Provided that patients with PD are rigorously selected for neurosurgery, subthalamic stimulation (1) improves mood, anxiety, and quality of life; (2) does not result in severe permanent psychiatric disorders or modify patients' personality; and (3) does not ameliorate social adaptation.
authors.affiliation: Centre d'Investigations Cliniques, Hôpital de la Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Houeto
authors.forename: Luc
authors.initials: L
authors.lastname: Mallet
authors.forename: Valérie
authors.initials: V
authors.lastname: Mesnage
authors.forename: Sophie
authors.initials: S
authors.lastname: Tezenas du Montcel
authors.forename: Cécile
authors.initials: C
authors.lastname: Béhar
authors.forename: Marcela
authors.initials: M
authors.lastname: Gargiulo
authors.forename: Frederic
authors.initials: F
authors.lastname: Torny
authors.forename: Antoine
authors.initials: A
authors.lastname: Pelissolo
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Welter
authors.forename: Yves
authors.initials: Y
authors.lastname: Agid
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D001519:Behavior / Q000502:physiology; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D011446:Prospective Studies; D012917:Social Adjustment; D020531:Subthalamic Nucleus / Q000502:physiology