Subthalamic nucleus stimulation does not cause deterioration of preexisting hallucinations in Parkinson's disease patients.
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 On the other hand, anti-parkinsonian drugs were totally withdrawn in 1 patient, but without improvement of hallucination.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.
Yoshida
Fumiaki
F
Department of Neurosurgery, Kyushu University, Higashi-ku, Fukuoka, Japan.
Miyagi
Yasushi
Y
Kishimoto
Junji
J
Morioka
Takato
T
Murakami
Nobuya
N
Hashiguchi
Kimiaki
K
Samura
Kazuhiro
K
Sakae
Nobutaka
N
Yamasaki
Ryo
R
Kawaguchi
Minako
M
Sasaki
Tomio
T
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
D000978:Antiparkinson Agents; D007980:Levodopa