Subthalamic stimulation in Parkinson disease: behavior and social adaptation.
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.
Houeto
Jean-Luc
JL
Centre d'Investigations Cliniques, Hôpital de la Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France.
Mallet
Luc
L
Mesnage
Valérie
V
Tezenas du Montcel
Sophie
S
Béhar
Cécile
C
Gargiulo
Marcela
M
Torny
Frederic
F
Pelissolo
Antoine
A
Welter
Marie-Laure
ML
Agid
Yves
Y
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