Background:
Deep brain stimulation (DBS) is a modern neuromodulation method
used in the treatment of advanced movement disorders such as Parkinson’s disease (PD) and
dystonia. Patients with PD may have multiple psychiatric comorbidities, notably anxiety, depression,
mania or hypomania, and psychosis. DBS surgery may indirectly alleviate psychiatric
symptoms by allowing reduction of dopaminergic medications, or as a result of functional
improvement. Patients who are considering DBS for PD often have more advanced disease
and may be more vulnerable to perioperative psychiatric decline. Albeit infrequently, increased
depression, apathy, irritability, hypomania or mania, and suicidal behavior have been
observed after DBS surgery.
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Objective: This review aimed to present current evidence and empirical recommendations for
the management of the psychiatric symptoms in patients with PD treated with DBS.
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Method: Relevant literature was reviewed and synthesized, along with recommendations informed
by the authors’ clinical experience in a large, academic DBS center.
Results:
Careful evaluation of DBS candidacy, including assessing the risk for perioperative
psychiatric decompensation is advised. Maintaining at least eight weeks of psychiatric stability
prior to DBS surgery is strongly recommended. Postoperative management can be challenging
due to advanced disease, concurrent psychiatric comorbidities, and possible DBS
stimulation-related effects on mood and impulse control. Stimulation-induced elevated mood
states (mania, hypomania) have started to be recognized as distinct clinical entities, although
not included in the current psychiatric nomenclature.
Conclusion:
Insufficient evidence-based strategies for managing psychiatric symptoms in PD
patients with DBS exist at this time. Further research is necessary to uncover best practices in
this complex, expanding field.
