Psychopharmacology for Patients with Parkinson’s Disease and Deep Brain Stimulation: Lessons Learned in an Academic Center

2019 ◽  
Vol 8 (1) ◽  
pp. 41-54 ◽  
Author(s):  
Andreea L. Seritan ◽  
Peter Ureste ◽  
Tammy Duong ◽  
Jill L. Ostrem
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Advanced Disease ◽  
Psychiatric Symptoms ◽  
Functional Improvement ◽  
Current Evidence ◽  
Psychiatric Comorbidities ◽  
Deep Brain

Background:Deep brain stimulation (DBS) is a modern neuromodulation method used in the treatment of advanced movement disorders such as Parkinson’s disease (PD) and dystonia. Patients with PD may have multiple psychiatric comorbidities, notably anxiety, depression, mania or hypomania, and psychosis. DBS surgery may indirectly alleviate psychiatric symptoms by allowing reduction of dopaminergic medications, or as a result of functional improvement. Patients who are considering DBS for PD often have more advanced disease and may be more vulnerable to perioperative psychiatric decline. Albeit infrequently, increased depression, apathy, irritability, hypomania or mania, and suicidal behavior have been observed after DBS surgery. </P><P> Objective: This review aimed to present current evidence and empirical recommendations for the management of the psychiatric symptoms in patients with PD treated with DBS. </P><P> Method: Relevant literature was reviewed and synthesized, along with recommendations informed by the authors’ clinical experience in a large, academic DBS center.Results:Careful evaluation of DBS candidacy, including assessing the risk for perioperative psychiatric decompensation is advised. Maintaining at least eight weeks of psychiatric stability prior to DBS surgery is strongly recommended. Postoperative management can be challenging due to advanced disease, concurrent psychiatric comorbidities, and possible DBS stimulation-related effects on mood and impulse control. Stimulation-induced elevated mood states (mania, hypomania) have started to be recognized as distinct clinical entities, although not included in the current psychiatric nomenclature.Conclusion:Insufficient evidence-based strategies for managing psychiatric symptoms in PD patients with DBS exist at this time. Further research is necessary to uncover best practices in this complex, expanding field.

Management of impulse control disorders in Parkinson's disease

2016 ◽  
Vol 28 (10) ◽  
pp. 1597-1614 ◽  
Author(s):  
Susan Zhang ◽  
Nadeeka N. Dissanayaka ◽  
Andrew Dawson ◽  
John D. O'Sullivan ◽  
Philip Mosley ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Impulse Control ◽  
Impulse Control Disorders ◽  
Current Evidence ◽  
Evidence Based ◽  
Pharmacological Treatments ◽  
Deep Brain

ABSTRACTBackground:Impulse control disorders (ICDs) have become a widely recognized non-motor complication of Parkinson's disease (PD) in patients taking dopamine replacement therapy (DRT). There are no current evidence-based recommendations for their treatment, other than reducing their dopaminergic medication.Methods:This study reviews the current literature of the treatment of ICDs including pharmacological treatments, deep brain stimulation, and psychotherapeutic interventions.Results:Dopamine agonist withdrawal is the most common and effective treatment, but may lead to an aversive withdrawal syndrome or motor symptom degeneration in some individuals. There is insufficient evidence for all other pharmacological treatments in treating ICDs in PD, including amantadine, serotonin selective reuptake inhibitors, antipsychotics, anticonvulsants, and opioid antagonists (e.g. naltrexone). Large randomized control trials need to be performed before these drugs can be routinely used for the treatment of ICDs in PD. Deep brain stimulation remains equivocal because ICD symptoms resolve in some patients after surgery but may appearde novoin others. Cognitive behavioral therapy has been shown to improve ICD symptoms in the only published study, although further research is urgently needed.Conclusions:Further research will allow for the development of evidence-based guidelines for the management of ICDs in PD.

scholarly journals Programming for Stimulation-Induced Transient Nonmotor Psychiatric Symptoms after Bilateral Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s Disease

2017 ◽  
Vol 2017 ◽  
pp. 1-14
Author(s):  
Xi Wu ◽  
Yiqing Qiu ◽  
Keith Simfukwe ◽  
Jiali Wang ◽  
Jianchun Chen ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Psychiatric Symptoms ◽  
Flow Diagram ◽  
Stimulation Parameter ◽  
Stn Dbs ◽  
Deep Brain

Background. Stimulation-induced transient nonmotor psychiatric symptoms (STPSs) are side effects following bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD) patients. We designed algorithms which (1) determine the electrode contacts that induce STPSs and (2) provide a programming protocol to eliminate STPS and maintain the optimal motor functions. Our objective is to test the effectiveness of these algorithms. Materials and Methods. 454 PD patients who underwent programming sessions after STN-DBS implantations were retrospectively analyzed. Only STPS patients were enrolled. In these patients, the contacts inducing STPS were found and the programming protocol algorithms used. Results. Eleven patients were diagnosed with STPS. Of these patients, two had four episodes of crying, and two had four episodes of mirthful laughter. In one patient, two episodes of abnormal sense of spatial orientation were observed. Hallucination episodes were observed twice in one patient, while five patients recorded eight episodes of hypomania. There were no statistical differences between the UPDRS-III under the final stimulation parameter (without STPS) and previous optimum UPDRS-III under the STPSs (p=1.000). Conclusion. The flow diagram used for determining electrode contacts that induce STPS and the programming protocol employed in the treatment of these symptoms are effective.

scholarly journals Lateralized effects of deep brain stimulation in Parkinson’s disease: evidence and controversies

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Zhengyu Lin ◽  
Chencheng Zhang ◽  
Dianyou Li ◽  
Bomin Sun
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Current Evidence ◽  
Motor Symptoms ◽  
Pubmed Database ◽  
Motor Outcomes ◽  
Stn Dbs ◽  
Deep Brain

AbstractThe bilateral effects of deep brain stimulation (DBS) on motor and non-motor symptoms of Parkinson’s disease (PD) have been extensively studied and reviewed. However, the unilateral effects—in particular, the potential lateralized effects of left- versus right-sided DBS—have not been adequately recognized or studied. Here we summarized the current evidence and controversies in the literature regarding the lateralized effects of DBS on motor and non-motor outcomes in PD patients. Publications in English language before February 2021 were obtained from the PubMed database and included if they directly compared the effects of unilateral versus contralateral side DBS on motor or non-motor outcomes in PD. The current literature is overall of low-quality and is biased by various confounders. Researchers have investigated mainly PD patients receiving subthalamic nucleus (STN) DBS while the potential lateralized effects of globus pallidus interna (GPi) DBS have not been adequately studied. Evidence suggests potential lateralized effects of STN DBS on axial motor symptoms and deleterious effects of left-sided DBS on language-related functions, in particular, the verbal fluency, in PD. The lateralized DBS effects on appendicular motor symptoms as well as other neurocognitive and neuropsychiatric domains remain inconclusive. Future studies should control for varying methodological approaches as well as clinical and DBS management heterogeneities, including symptom laterality, stimulation parameters, location of active contacts, and lead trajectories. This would contribute to improved treatment strategies such as personalized target selection, surgical planning, and postoperative management that ultimately benefit patients.

Suicide in Parkinson’s Disease: A Systematic Review

2019 ◽  
Vol 18 (6) ◽  
pp. 466-477 ◽  
Author(s):  
Isabella Berardelli ◽  
Daniele Belvisi ◽  
Adele Nardella ◽  
Giulia Falcone ◽  
Dorian A. Lamis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Suicidal Ideation ◽  
Brain Stimulation ◽  
Suicide Risk ◽  
Psychiatric Symptoms ◽  
Search Terms ◽  
Deep Brain

: Psychiatric disorders and suicide have been reported in patients suffering from Parkinson’s disease. The aims of the present paper were to determine whether patients with Parkinson’s disease have an increased rate of suicide and to identify the clinical features possibly associated with suicide risk in Parkinson’s disease. We also reviewed the studies on suicide risk in Parkinson’s disease in patients after deep brain stimulation. We performed a Medline, Excerpta Medica, PsycLit, PsycInfo and Index Medicus search to identify all articles published on this topic from 1970 to 2019. The following search terms were used: suicide OR suicide attempt OR suicidal ideation OR suicide risk AND Parkinson’s disease AND Parkinson’s disease and deep brain stimulation. The studies we identified that assessed the suicide rate associated with Parkinson’s disease yielded contrasting results, although an increase in suicidal ideation did emerge. The studies on the effect of deep brain stimulation on suicide risk in Parkinson’s disease also reported mixed findings. Psychiatric symptoms, including depression, appear to be associated with suicide risk in patients with Parkinson’s disease undergoing medical and after surgical treatment. The studies reviewed suggest that suicidal ideation is increased in Parkinson’s disease. Further longitudinal studies designed to assess suicidality in this condition are still needed.

scholarly journals Caregiver Burden and Caregiver Appraisal of Psychiatric Symptoms are not Modulated by Subthalamic Deep Brain Stimulation for Parkinson’s Disease

2017 ◽  
Author(s):  
Philip E Mosley ◽  
Michael Breakspear ◽  
Terry Coyne ◽  
Peter Silburn ◽  
David Smith
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Caregiver Burden ◽  
Brain Stimulation ◽  
Postoperative Period ◽  
Psychiatric Symptoms ◽  
Substantial Contribution ◽  
Baseline Values ◽  
Deep Brain

Subthalamic deep brain stimulation is an advanced therapy that typically improves quality of life for persons with Parkinson’s disease (PD). However, the effect on caregiver burden is unclear. We recruited sixty-four persons with PD and their caregivers from a movement disorders clinic during the assessment of eligibility for subthalamic DBS. We used clinician, patient and caregiver-rated instruments to follow the patient-caregiver dyad from pre- to postoperative status, sampling repeatedly in the postoperative period to ascertain fluctuations in phenotypic variables. We employed multivariate models to identify key drivers of burden. We clustered caregiver-rated variables into ‘high’ and ‘low’ symptom groups and examined whether postoperative cluster assignment could be predicted from baseline values. Psychiatric symptoms in the postoperative period made a substantial contribution to longitudinal caregiver burden. The development of stimulation-dependent mood changes was also associated with increased burden. However, caregiver burden and caregiver-rated psychiatric symptom clusters were temporally stable and thus predicted only by their baseline values. We confirmed this finding using frequentist and Bayesian statistics, concluding that in our sample, subthalamic DBS for PD did not significantly influence caregiver burden or caregiver-rated psychiatric symptoms. Specifically, patient-caregiver dyads with high burden and high levels of psychiatric symptoms at baseline were likely to maintain this profile during follow up. These findings support the importance of assessing caregiver burden prior to functional neurosurgery. Furthermore, they suggest that interventions addressing caregiver burden in this population should target those with greater symptomatology at baseline and may usefully prioritise psychiatric symptoms reported by the caregiver.

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