title: Cognitive and neuropsychiatric effects of subthalamotomy for Parkinson's disease.
abstract: Since the advent of deep brain stimulation (DBS) for the treatment of Parkinson's disease (PD), subsequent cognitive and neuropsychiatric effects of this procedure have become well-chronicled. Yet, thermolitic lesion of the subthalamic nucleus (STN) is still a valid option when DBS cannot be applied, and little has been published regarding its impact on cognition and mood. We examined the cognitive and neuropsychiatric functions of 10 consecutive patients with advanced PD undergoing simultaneous bilateral subthalamotomies. With 24 months of follow-up, the patients, three of whom were on anticholinergics prior to surgery, showed no deterioration in cognitive assessments including verbal fluency. Hypoactive behaviors (depression and apathy) showed lasting improvement, while hyperactive behaviors (euphoria and disinhibition) transiently increased after surgery. Improvement in hypoactive behaviors correlated with improvement in hypokinetic movements, and enhanced hyperactive behaviors followed the course of post-operative hyperkinetic movements. Such correlations may support the role of the STN in modulating limbic connections between the basal ganglia and frontal cortex. The results of this proof-of-concept pilot study suggest the need for larger, long-term, randomized controlled studies to assess motor, neuropsychiatric, behavioral and radiologic correlations after subthalamotomies.
authors.affiliation: Division of Movement Disorders, Department of Neurology, University of Louisville School of Medicine, Frazier Rehab Neuroscience Institute, 220 Abraham Flexner Way, Ste 1503, Louisville, KY 40202, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Bickel
authors.forename: Lazaro
authors.initials: L
authors.lastname: Alvarez
authors.forename: Raul
authors.initials: R
authors.lastname: Macias
authors.forename: Nancy
authors.initials: N
authors.lastname: Pavon
authors.forename: Miraida
authors.initials: M
authors.lastname: Leon
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernandez
authors.forename: David J
authors.initials: DJ
authors.lastname: Houghton
authors.forename: Sonia
authors.initials: S
authors.lastname: Salazar
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodríguez-Oroz
authors.forename: Jorge
authors.initials: J
authors.lastname: Juncos
authors.forename: Jorge
authors.initials: J
authors.lastname: Guridi
authors.forename: Mahlon
authors.initials: M
authors.lastname: Delong
authors.forename: Jose A
authors.initials: JA
authors.lastname: Obeso
authors.forename: Irene
authors.initials: I
authors.lastname: Litvan
mesh_terms: D003072:Cognition Disorders / Q000209:etiology*; D006801:Humans; D001523:Mental Disorders / Q000209:etiology*; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010300:Parkinson Disease / Q000523:psychology / Q000601:surgery*; D020531:Subthalamic Nucleus / Q000601:surgery*