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Taking a Better History for Behavioral Issues Pre‐ and Post‐Deep Brain Stimulation: Issues Missed by Standardized Scales
Authors:Oscar Bernal‐Pacheco MD  Genko Oyama MD  PhD  Kelly D. Foote MD  Yunfeng E. Dai MS  Samuel S. Wu PhD  Charles E. Jacobson IV BS  Natlada Limotai MD  Pamela R. Zeilman ARNP  Janet Romrell PA  Nelson Hwynn DO  Ramon L. Rodriguez MD  Irene A. Malaty MD  Michael S. Okun MD
Affiliation:1. Departments of Neurology Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA;2. Departments of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA;3. and;4. Department of Biostatistics, University of Florida, Gainesville, FL, USA
Abstract:Objectives: To screen for potentially underreported behavioral changes in patients with idiopathic Parkinson's disease (PD) pre‐ and post‐deep brain stimulation (DBS), a retrospective data base review was performed. Methods: In total, 113 patients who underwent unilateral or bilateral DBS at the University of Florida in either subthalamic nucleus or globus pallidus internus for PD were screened for behavioral issues by asking about the presence or absence of seven neuropsychiatric symptoms (panic, fear, paranoia, anger, suicidal flashes, crying, and laughing). Results: There was a high prevalence of fear (16.3%), panic (14.0%), and anger (11.6%) at baseline in this cohort. In the first six months following DBS implantation, anger (32.6%), fear (26.7%), and uncontrollable crying (26.7%) were the most frequent symptoms reported. Those symptoms also were present following six months of DBS surgery (30.2%, 29.1%, and 19.8%, respectively). New uncontrollable crying occurred more in the acute postoperative stage (less than or equal to six months) (p= 0.033), while new anger occurred more in the chronic postoperative stage (greater than six months) (p= 0.017). The frequency of uncontrollable laughing significantly increased with bilateral DBS (p= 0.033). Conclusions: Many of the neuropsychiatric issues were identified at preoperative baseline and their overall occurrence was more than expected. There was a potential for worsening of these issues post‐DBS. There were subtle differences in time course, and in unilateral vs. bilateral implantations. Clinicians should be aware of these potential behavioral issues that may emerge following DBS therapy, and should consider including screening questions in preoperative and postoperative interviews. Standardized scales may miss the presence or absence of these clinically relevant issues.
Keywords:Adverse events  complications  deep brain stimulation  monitoring  screening
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