Psychiatric effects of Deep Brain Stimulation in Parkinson’s disease: Preliminary findings of a prospective study
Objective: To examine the impact of Deep Brain Stimulation on mood, behavior and sexual function.
Design: open, prospective
Methods: Eight consecutive patients (mean age: 62, mean duration of Parkinson’s disease: 9.5 years) who underwent deep brain stimulation (DBS) surgery were evaluated pre-operatively and then re-examined at approximately 2 months after the initial programming of their stimulator(s). The battery of tests performed include: Montgomery-Asberg Depression Rating Scale (MADRS), Neuropsychiatric Inventory (NPI), Derogatis Interview for Sexual Functioning-Self Report (DISF-SR), Mini Mental State Examination (MMSE), the mood disorder modules of Structured Clinical Interview for DSM-IV (SCID) and the Unified Parkinson’s Disease Rating Scale (UPDRS).
Results: Parkinsonian motor disability as measured with UPDRS was improved by a mean average of 39.8% and the levodopa equivalent daily dosage was reduced by an average of 7%. None of the patients qualified for a SCID diagnosis of major depression either at the time of the evaluation or at any point in their lifetime. Six patients had sub-syndromal depressive symptoms at baseline and met criteria for Depressive Disorder NOS. Two of those were treated with an antidepressant at the time of the evaluations. None of the pre-post comparisons for the non-motor measures reached statistical significance. However, there was a trend towards both improved behavior as measured by NPI (pre-DBS mean NPI: 13.5 with SD: 18.5 compared to post-DBS NPI: 8.9 with SD: 11.6) as well as improved mood as measured by MADRS (pre-DBS mean MADRS: 13.6 with SD: 5.7 compared to post-DBS MADRS: 10.9 with SD: 8.7). No significant correlation was found between the improvements in motor disability (UPDRS) and those in either the NPI or the MADRS.
Conclusion: We found no adverse effect of DBS on mood or behavior and some evidence for improvement on two psychiatric measures. There was no evidence that sexual functioning or cognition is significantly affected in the early post-stimulation period. Further follow-up is needed to illuminate whether DBS surgery will affect in any significant way the psychiatric status of these Parkinsonian patients in the long-term. We plan to repeat the SCID at 1-year post-DBS to determine if any patient develops major depression. We will also include a control group of PD patients on antiparkinsonian meds only. At present, it seems prudent to perform a careful psychiatric evaluation pre- and post- operatively to identify individuals at high risk of psychiatric morbidity and to ensure timely intervention.
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