Mental Side Effects of Deep Brain Stimulation (DBS) for Movement Disorders: The Futility of Denial

‘Woe Betides Anybody Who Tries to Turn me Down.’ A Qualitative Analysis of Neuropsychiatric Symptoms Following Subthalamic Deep Brain Stimulation for Parkinson’s Disease

“…Unexpected and harmful neuropsychiatric symptoms may occur after STN-DBS, despite the oversight of a large and experienced movement disorders centre that follows best practice guidelines, including an embedded psychiatrist, preoperative psychiatric evaluation of all surgical candidates and a preoperative education programme delivered to spousal caregivers. It has previously been suggested that neuropsychiatric effects may be an integral, albeit unintended, consequence of STN-DBS for PD [24]. Other nuclei in the basal ganglia, specifically the internal segment of the globus pallidus (GPi), have been advanced as a Bsafer^target for DBS [43] but these outcomes have been contested [44 45].…”

“…In particular, these authors propose that debate regarding the neuroethical consequences of DBS relies largely upon speculative assumptions rather than empirical evidence. However, clinical experience indicates that a substantial proportion of psychiatric symptoms arise de novo and in the absence of prior symptomatology, suggesting that there is not a clear 'at-risk' pre-surgical phenotype and that these symptoms may be an unintended consequence of the procedure [24]. Furthermore, the physiological role of the STN in decision-making lends biological plausibility to the view that modulation of this region may produce unintended cognitive and emotional side effects [25].…”

Differential contributions of subthalamic beta rhythms and neural noise to Parkinson motor symptoms

“…Our two-components modeling technique has direct applications for closed-loop DBS. Despite the benefits of continuous DBS, several studies have reported different side-effects, affecting mood, behavior, speech and personality [30]. One way to minimize the associated side-effects of DBS is to reduce the stimulation time using closed-loop systems, limiting the appearance of motor symptoms measured by specific biomarkers.…”

Beta-driven closed-loop deep brain stimulation can compromise human motor behavior in Parkinson’s Disease

“…Benefits of deep brain stimulation (DBS) for Parkinson's disease (PD) are numerous (Limousin et al, 2005;Deuschl et al, 2006;Benabid et al, 2009;Schuepbach et al, 2013). However, several studies have reported side-effects affecting mood, behavior, moral competence, speech and personality (Klostermann et al, 2008;Cyron, 2016). A promising approach to minimize those side-effects is to reduce the stimulation time using a closed-loop system, in which the stimulation parameters are adapted in real-time based on biomarkers reflecting the clinical state of the patient.…”