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Psychosis from subthalamic nucleus deep brain stimulator lesion effect

BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) in particular is highly effective in relieving symptoms of Parkinson's disease (PD). However, it can also have marked psychiatric side effects, including delirium, mania, and psychosis. The etiologies of those effects are...

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Autores principales: Widge, Alik S., Agarwal, Pinky, Giroux, Monique, Farris, Sierra, Kimmel, Ryan J., Hebb, Adam O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589868/
https://www.ncbi.nlm.nih.gov/pubmed/23493632
http://dx.doi.org/10.4103/2152-7806.106265
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author Widge, Alik S.
Agarwal, Pinky
Giroux, Monique
Farris, Sierra
Kimmel, Ryan J.
Hebb, Adam O.
author_facet Widge, Alik S.
Agarwal, Pinky
Giroux, Monique
Farris, Sierra
Kimmel, Ryan J.
Hebb, Adam O.
author_sort Widge, Alik S.
collection PubMed
description BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) in particular is highly effective in relieving symptoms of Parkinson's disease (PD). However, it can also have marked psychiatric side effects, including delirium, mania, and psychosis. The etiologies of those effects are not well-understood, and both surgeons and consulting psychiatrists are in need of treatment strategies. CASE DESCRIPTION: Two patients with young onset of PD and without significant prior psychiatric problems presented for bilateral STN DBS when medications became ineffective. Both had uneventful operative courses but developed florid psychosis 1-2 weeks later, before stimulator activation. Neither showed signs of delirium, but both required hospitalization, and one required treatment with a first-generation antipsychotic drug. Use of that drug did not worsen PD symptoms, contrary to usual expectations. CONCLUSION: These cases describe a previously unreported post-DBS syndrome in which local tissue reaction to lead implantation produces psychosis even without electrical stimulation of subcortical circuits. The lesion effect also appears to have anti-Parkinsonian effects that may allow the safe use of otherwise contraindicated medications. These cases have implications for management of PD DBS patients postoperatively, and may also be relevant as DBS is further used in other brain regions to treat behavioral disorders.
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spelling pubmed-35898682013-03-14 Psychosis from subthalamic nucleus deep brain stimulator lesion effect Widge, Alik S. Agarwal, Pinky Giroux, Monique Farris, Sierra Kimmel, Ryan J. Hebb, Adam O. Surg Neurol Int Case Report BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) in particular is highly effective in relieving symptoms of Parkinson's disease (PD). However, it can also have marked psychiatric side effects, including delirium, mania, and psychosis. The etiologies of those effects are not well-understood, and both surgeons and consulting psychiatrists are in need of treatment strategies. CASE DESCRIPTION: Two patients with young onset of PD and without significant prior psychiatric problems presented for bilateral STN DBS when medications became ineffective. Both had uneventful operative courses but developed florid psychosis 1-2 weeks later, before stimulator activation. Neither showed signs of delirium, but both required hospitalization, and one required treatment with a first-generation antipsychotic drug. Use of that drug did not worsen PD symptoms, contrary to usual expectations. CONCLUSION: These cases describe a previously unreported post-DBS syndrome in which local tissue reaction to lead implantation produces psychosis even without electrical stimulation of subcortical circuits. The lesion effect also appears to have anti-Parkinsonian effects that may allow the safe use of otherwise contraindicated medications. These cases have implications for management of PD DBS patients postoperatively, and may also be relevant as DBS is further used in other brain regions to treat behavioral disorders. Medknow Publications & Media Pvt Ltd 2013-01-18 /pmc/articles/PMC3589868/ /pubmed/23493632 http://dx.doi.org/10.4103/2152-7806.106265 Text en Copyright: © 2013 Widge AS http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Case Report
Widge, Alik S.
Agarwal, Pinky
Giroux, Monique
Farris, Sierra
Kimmel, Ryan J.
Hebb, Adam O.
Psychosis from subthalamic nucleus deep brain stimulator lesion effect
title Psychosis from subthalamic nucleus deep brain stimulator lesion effect
title_full Psychosis from subthalamic nucleus deep brain stimulator lesion effect
title_fullStr Psychosis from subthalamic nucleus deep brain stimulator lesion effect
title_full_unstemmed Psychosis from subthalamic nucleus deep brain stimulator lesion effect
title_short Psychosis from subthalamic nucleus deep brain stimulator lesion effect
title_sort psychosis from subthalamic nucleus deep brain stimulator lesion effect
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589868/
https://www.ncbi.nlm.nih.gov/pubmed/23493632
http://dx.doi.org/10.4103/2152-7806.106265
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