Neurosurgery in Parkinson disease - A distressed mind in a repaired body?

Centre d'Investigation Clinique, Fédération des Maladies du Système Nerveux, INSERM U679, Université Paris VI, CHU Pitié-Salpêtrière, Paris, France.
Neurology (Impact Factor: 8.3). 07/2006; 66(12):1811-6. DOI: 10.1212/01.wnl.0000234880.51322.16
Source: PubMed

ABSTRACT To prospectively evaluate the impact of subthalamic nucleus (STN) stimulation on social adjustment in patients with Parkinson disease (PD).
Before and 18 to 24 months after bilateral STN stimulation, the authors assessed 29 patients with PD for motor disability, cognition (Mattis dementia rating scale, frontal score), psychiatric morbidity (Mini-5.0.0, MADRS, BAS), quality of life (PDQ-39), social adjustment (Social Adjustment Scale), and psychological status using unstructured in-depth interviews.
Despite marked improvement in parkinsonian motor disability, the absence of significant changes in cognitive status, and improvement of activities of daily living and quality of life by the end of the study, social adjustment did not improve. Several kinds of problems with social adjustment were observed, affecting the patients' perception of themselves and their body, marital situation, and professional life. Marital conflicts occurred in 17/24 couples. Only 9 out of 16 patients who had a professional activity before the operation went back to work after surgery.
After STN stimulation, patients experienced difficulties in their relations with themselves, their spouses, their families, and their socio-professional environment. The authors suggest a multidisciplinary psychosocial preparation and follow-up to help patients and their entourage cope with the sudden changes in their existence following successful neurosurgery.

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    • "Moreover, the established improvement of quality of life in operated patients [3–6,48,49] contrasts with the increased risk for suicides [50] [51] and failed psychosocial adjustment [41] [42] after surgery. These conflicting observations, recently reviewed by Fasano et al. [12,Table 2] make it difficult to advise patients before surgery and to provide reliable information about risk for psychiatric and behavioral complications. "
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    ABSTRACT: Subthalamic nucleus (STN) stimulation in advanced Parkinson’s disease is a very powerful treatment for a highly selected group of patients. However, behavioral problems after neurosurgery have frequently been reported and may hamper the therapeutic success. In particular, impulsivity and impulse control disorders are often discussed as adverse effects of STN stimulation, and there is an ongoing debate whether stimulation causes or improves behavioral problems. We here point out that behavior after surgery for STN stimulation depends on five interacting factors: (1) impulsivity as an effect of STN stimulation, (2) hypo- and hyperdopaminergic behaviors as a result of changes of dopaminergic medication, (3) individually different mesolimbic denervation, (4) exact location of the electrode within the STN, and (5) reactive psychosocial changes. The complex interplay of these factors has so far not been taken into account appropriately to understand the postoperative behavioral events. We here propose a two axes model that may help clinicians understand the effects of treatment changes after neurosurgery and provide a basis for optimization of stimulation parameter programming and adjustment of dopaminergic medication.
    12/2012; 2(4):205–209. DOI:10.1016/j.baga.2012.09.005
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    • "Non-motor symptoms of PD have received more attention in recent years and seem to play a pivotal role in the change in quality of life caused by the amelioration of motor disabilities through medical or surgical treatment [31]. An increased percentage of post-stimulation behavioral and cognitive complications is still a major concern for STN-DBS [27] [32] [33] as it is not conclusively known whether DBS causes a change in these non-motor symptoms. "
    Towards New Therapies for Parkinson's Disease, 11/2011; , ISBN: 978-953-307-463-4
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    • "" [5] suggest that psychosocial factors after DBS may have a large impact on patients. The psychosocial challenges that may present after DBS have been explored by Agid and colleagues [4] [5] [6]. In their qualitative interview study of PD DBS patients, the authors observed that some patients faced a range of psychosocial challenges including what they interpret to be repercussions and difficulties for the " self " (the patient), with " the other " (the spouse) and with " others " [4]. "
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    ABSTRACT: Background. Although the clinical effectiveness of deep brain stimulation (DBS) in Parkinson's disease is established, there has been less examination of its social aspects. Methods and Results. Building on qualitative comments provided by healthcare providers, we present four different social and relational issues (need for social support, changes in relationships (with self and partner) and challenges with regards to occupation and the social system). We review the literature from multiple disciplines on each issue. We comment on their ethical implications and conclude by establishing the future prospects for research with the possible expansion of DBS for psychiatric indications. Conclusions. Our review demonstrates that there are varied social issues involved in DBS. These issues may have significant impacts on the perceived outcome of DBS by patients. Moreover, the fact that the social impact of DBS is still not well understood in emerging psychiatric indications presents an important area for future examination.
    04/2011; 2011:871874. DOI:10.4061/2011/871874
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