Cognitive and neuropsychiatric effects of subthalamotomy for Parkinson's disease.
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.
Bickel
Scott
S
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.
Alvarez
Lazaro
L
Macias
Raul
R
Pavon
Nancy
N
Leon
Miraida
M
Fernandez
Cristina
C
Houghton
David J
DJ
Salazar
Sonia
S
Rodríguez-Oroz
Maria C
MC
Juncos
Jorge
J
Guridi
Jorge
J
Delong
Mahlon
M
Obeso
Jose A
JA
Litvan
Irene
I
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*