title: Subthalamic nucleus stimulation does not cause deterioration of preexisting hallucinations in Parkinson's disease patients.
abstract: BACKGROUND
  Among the neuropsychiatric symptoms in Parkinson's disease (PD) patients, hallucination can result from the disease itself or medical treatment. Hallucination associated with subthalamic nucleus stimulation (STN-DBS) has been reported; however, it is still unclear whether PD patients with a history of hallucination are appropriate candidates for STN-DBS or not.
  
  
  OBJECTIVE
  We investigated the effect of STN-DBS on preexisting hallucination associated with advanced PD.
  
  
  METHODS
  Eighteen STN-DBS patients were investigated retrospectively. The severity of hallucination was assessed by the thought disorder score on the Unified Parkinson's Disease Rating Scale (UPDRS, part 1-item 2) in the patients' interviews; the score 6 months after the initiation of STN-DBS was compared with the highest score throughout the preoperative history and the score 2 weeks before surgery.
  
  
  RESULTS
  Hoehn-Yahr stage and motor score (UPDRS part 3) were significantly improved following STN-DBS. Six months after the initiation of STN-DBS, the severity of hallucination, assessed by thought disorder score, did not increase, but rather decreased compared with the preoperative level (p < 0.05 by McNemar's test). The daily levodopa equivalent dose was increased in 2 patients without the development of hallucination. On the other hand, anti-parkinsonian drugs were totally withdrawn in 1 patient, but without improvement of hallucination.
  
  
  CONCLUSIONS
  Our findings indicate that STN-DBS surgery does not always lead to deterioration of preexisting hallucination in PD. In advanced PD, hallucination involves a multifactorial pathogenesis and a history of hallucination is not a contraindication to STN-DBS surgery.
authors.affiliation: Department of Neurosurgery, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Yoshida
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyagi
authors.forename: Junji
authors.initials: J
authors.lastname: Kishimoto
authors.forename: Takato
authors.initials: T
authors.lastname: Morioka
authors.forename: Nobuya
authors.initials: N
authors.lastname: Murakami
authors.forename: Kimiaki
authors.initials: K
authors.lastname: Hashiguchi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Samura
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Sakae
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamasaki
authors.forename: Minako
authors.initials: M
authors.lastname: Kawaguchi
authors.forename: Tomio
authors.initials: T
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006212:Hallucinations / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa