Subthalamic nucleus stimulation for Parkinson disease with severe medication-induced hallucinations or delusions

Clinical article

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Object

Subthalamic nucleus deep brain stimulation (STN DBS) improves cardinal motor symptoms of Parkinson disease (PD) and reduces antiparkinsonian medication. Therefore, STN DBS seems to be well indicated for patients suffering from medication-induced psychotic symptoms. However, there are few available data dealing with the effect of STN DBS in this kind of patient. The authors studied the effect of STN DBS in patients with PD and severe medication-induced hallucinations or delusions.

Methods

The authors retrospectively reviewed the clinical course of 10 patients who suffered from severe medication-induced hallucinations or delusions and underwent bilateral STN DBS. Patients whose preoperative thought disorder score (Unified Parkinson's Disease Rating Scale Part I, item 2) was 3 or more were enrolled in this study. All patients underwent cognitive function examination and brain perfusion SPECT preoperatively to exclude dementia with Lewy bodies.

Results

Subthalamic nucleus DBS yielded significant improvement of motor function in all patients. In 8 patients, psychotic symptoms completely disappeared with significant reduction of dopaminergic medication. In 2 patients, hallucinations and delusions deteriorated immediately after surgery despite complete withdrawal of antiparkinsonian medication. However, these psychotic symptoms completely disappeared after a few months with administration of antipsychotics, and no recurrence was observed afterward in either patient.

Conclusions

Subthalamic nucleus DBS is a good treatment option for patients with PD who are suffering severe medication-induced hallucinations or delusion. However, vigilance is needed, because temporary deterioration of psychotic symptoms may occur after surgery.

Abbreviations used in this paper: DBS = deep brain stimulation; DLB = dementia with Lewy bodies; LEDD = levodopa-equivalent daily dosage; MMSE = Mini-Mental State Examination; PD = Parkinson disease; STN = subthalamic nucleus; UPDRS = Unified Parkinson's Disease Rating Scale.

Article Information

Address correspondence to: Atsushi Umemura, M.D., Department of Neurosurgery, Nagoya City University Graduate School of Medicine, 1 Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan. email: aume@med.nagoya-cu.ac.jp.

Please include this information when citing this paper: published online March 4, 2011; DOI: 10.3171/2011.2.JNS101261.

© AANS, except where prohibited by US copyright law.

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References

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