title: Taking a better history for behavioral issues pre- and post-deep brain stimulation: issues missed by standardized scales.
abstract: OBJECTIVE
  To screen for potentially underreported behavioral changes in patients with idiopathic Parkinson's disease (PD) pre- and post-deep brain stimulation (DBS), a retrospective data base review was performed.
  
  
  METHODS
  In total, 113 patients who underwent unilateral or bilateral DBS at the University of Florida in either subthalamic nucleus or globus pallidus internus for PD were screened for behavioral issues by asking about the presence or absence of seven neuropsychiatric symptoms (panic, fear, paranoia, anger, suicidal flashes, crying, and laughing).
  
  
  RESULTS
  There was a high prevalence of fear (16.3%), panic (14.0%), and anger (11.6%) at baseline in this cohort. In the first six months following DBS implantation, anger (32.6%), fear (26.7%), and uncontrollable crying (26.7%) were the most frequent symptoms reported. Those symptoms also were present following six months of DBS surgery (30.2%, 29.1%, and 19.8%, respectively). New uncontrollable crying occurred more in the acute postoperative stage (less than or equal to six months) (p = 0.033), while new anger occurred more in the chronic postoperative stage (greater than six months) (p = 0.017). The frequency of uncontrollable laughing significantly increased with bilateral DBS (p = 0.033).
  
  
  CONCLUSIONS
  Many of the neuropsychiatric issues were identified at preoperative baseline and their overall occurrence was more than expected. There was a potential for worsening of these issues post-DBS. There were subtle differences in time course, and in unilateral vs. bilateral implantations. Clinicians should be aware of these potential behavioral issues that may emerge following DBS therapy, and should consider including screening questions in preoperative and postoperative interviews. Standardized scales may miss the presence or absence of these clinically relevant issues.
authors: Departments of Neurology Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA.
authors: Oscar
authors: O
authors: Bernal-Pacheco
authors: Genko
authors: G
authors: Oyama
authors: Kelly D
authors: KD
authors: Foote
authors: Yunfeng E
authors: YE
authors: Dai
authors: Samuel S
authors: SS
authors: Wu
authors: Charles E
authors: CE
authors: Jacobson
authors: Natlada
authors: N
authors: Limotai
authors: Pamela R
authors: PR
authors: Zeilman
authors: Janet
authors: J
authors: Romrell
authors: Nelson
authors: N
authors: Hwynn
authors: Ramon L
authors: RL
authors: Rodriguez
authors: Irene A
authors: IA
authors: Malaty
authors: Michael S
authors: MS
authors: Okun
mesh_terms: D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000523:psychology*; D006801:Humans; D010300:Parkinson Disease / Q000523:psychology* / Q000628:therapy*; D012189:Retrospective Studies