Troubles neurologiques

Risk Factors for Psychiatric Complications after Deep Brain Stimulation in Patients with Parkinson’s Disease: An Observational Study

Abstract

Akihiro Shiina, Tatsuya Yamamoto, Yoshinori Higuchi, Yoshitaka Yamanaka, Shigeki Hirano, Masato Asahina and Masaomi Iyo

Background: Deep brain stimulation (DBS) of the subthalamic nucleus is an effective treatment option for patients with Parkinson’s disease (PD). The risk factors associated with the occurrence of psychiatric symptoms have not been completely elucidated.
Methods: We conducted a naturalistic observational study on patients with PD who would be subjected to DBS. Clinical data, including motor functions, cognitive functions, mental status, and daily dosage of anti-PD drugs were monitored. A psychiatrist evaluated their psychiatric symptoms at the initial assessment, three months, and one year after DBS.
Results: We evaluated 44 participants with PD, of which 32 were subjected to DBS. Thirteen participants were diagnosed with mental disorders at the initial assessment. Twenty-six patients were reassessed at three months after surgery, and 19 participants were reassessed at one year. At three months, the motor function of the participants was significantly improved, and the mean anti-PD drug dose was significantly decreased. Sixteen participants were experiencing some psychiatric symptoms, of which 12 were considered as worsened due to DBS, whereas 6 participants experienced improved mental state. At one year, 6 participants were suffering from some psychiatric symptoms caused by DBS, whereas improvement was observed in 6 participants. An exploratory analysis revealed that participants without dopamine dysregulation syndrome (DDS) at the screening were likely to improve their psychiatric symptoms.
Conclusion: Although DBS caused some psychiatric complications, mental status was improved in some patients in a longitudinal course. DDS is possible to predict poor outcome in psychiatric complication after DBS in PD patients.