Stimulation-Induced Transient Nonmotor Psychiatric Symptoms following Subthalamic Deep Brain Stimulation in Patients with Parkinson's Disease: Association with Clinical Outcomes and Neuroanatomical Correlates

Abstract

Background: The clinical and neurobiological underpinnings of transient nonmotor (TNM) psychiatric symptoms during the optimization of stimulation parameters in the course of subthalamic nucleus deep brain stimulation (STN-DBS) remain under intense investigation. Methods: Forty-nine patients with refractory Parkinson's disease underwent bilateral STN-DBS implants and were enrolled in a 24-week prospective, naturalistic follow-up study. Patients who exhibited TNM psychiatric manifestations during DBS parameter optimization were evaluated for potential associations with clinical outcome measures. Results: Twenty-nine TNM+ episodes were reported by 15 patients. No differences between TNM+ and TNM- groups were found in motor outcome. However, unlike the TNM- group, TNM+ patients did not report improvement in subsyndromal depression or quality of life. TNM+ episodes were more likely to emerge during bilateral monopolar stimulation of the medial STN. Conclusions: The occurrence of TNM psychiatric symptoms during optimization of stimulation parameters was associated with the persistence of subsyndromal depression and with lower quality of life ratings at 6 months. The neurobiological underpinnings of TNM symptoms are investigated yet remain difficult to explain.

Programming for Stimulation-Induced Transient Nonmotor Psychiatric Symptoms after Bilateral Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s Disease

“…In the other four (04) patients, the active contacts were located in the lateral part of STN which also induced STPS. This is similar to what was reported by Abulseoud and colleagues [ 14 ]. For this reason, we concluded that the side effects of STPS are difficult to avoid by just implanting contacts into dorsolateral STN.…”

“…(1) In earlier studies, STPS was implicated with stimulation of the medial and inferior part (limbic part) of STN. However, recent studies show their active contacts located in the dorsolateral (sensorimotor) area of STN [ 14 ] which also induces STPS. Because of this reason, the limbic and sensorimotor regions of the STN overlap were greater than what has been previously reported [ 15 ].…”

Superolateral medial forebrain bundle deep brain stimulation in major depression: a gateway trial

“…In this study, we have intraoperatively looked for psychotropic effects that might possibly occur [31]. Euphoria, mirthful laughter, confusion, etc., typical psychiatric effects under STN DBS in Parkinson’s disease [32] have not been observed neither during surgical placement of electrodes and test stimulation nor in the context of chronic adjustment of stimulation parameters. We have occasionally seen some unilateral and mild aversive response during test stimulation (patients never mentioned “anxiety” but “aversiveness” on request) on more posterior electrode positions.…”

Deep Brain Stimulation of the Subthalamic Nucleus Modulates Reward-Related Behavior: A Systematic Review

“…The same acute vs. chronic distinction can be made regarding neuropsychiatric symptoms. Some symptoms occur immediately upon STN-DBS onset, such as hypomania, laughing or crying (Krack et al, 2001;Mallet et al, 2007;Wojtecki et al, 2007;Abulseoud et al, 2016), while other symptoms, typically apathy, progressively emerge with chronic stimulation (Drapier et al, 2006;Le Jeune et al, 2009).…”