Mania, progresive insomnia and irritability induced by bilateral deep brain stimulation (DBS) of the dorsal region of the subthalamic nucleus (STN) / zona incerta in patients with Parkinson´s disease (PD).

SOL CAVANAGH; SOL CAVANAGH; VERONICA BRUNO; SANTIAGO PEREZ-LLORET; M ROSSI; MARCELO MERELLO

Nueva Orleans, USA

Congreso; Congreso Internacional de Movimientos Anormales; 2006

Background: The effects of subthalamic nucleus (STN) deep brain stimulation (DBS) have shown to be an effective treatment for the severe fluctuation and dyskinesias induced by l-dopa in PD. Despite of this, several behavioural changes have been reported after DBS, including apathy, suicide attempt, depression, severe crying, insomnia and worsening of previous personality disorder. Patients and methods:  A 73-year-old male patient (case 1 –original observation–) who underwent bilateral STN-DBS because of severe fluctuating Parkinson’s disease developed dyskinesias despite having discontinued l-dopa treatment. Amantandine, which used to have a antidyskinetic effect before surgery, was unable to halt involuntary movements. Afterwards, surgery was performed in two more patients (cases 2 and 3 –studied cases–), in whom dyskinesias unresponsive to amantadine treatment, were also observed. Results: Both patients treated with DBS developed psychiatric complications and sleep disorders immediately after surgery, although they where not taking L-dopa. Patients were scored using UPDRS scale and treated with antipsychotics drugs without any improvement of their symptoms, but after, when the stimulations areas where changed, excluding the zona incerta, these psychiatric complications where gone. Conclusion: The stimulation of the Zona Incerta did not contribute with motor benefits to the stimulation of the NST and could be responsable of the psychiatric complications and sleep disorders.