Transient Perioperative Aggressive Behavior during Subthalamic Nucleus Deep Brain Stimulation for Parkinson's disease

Paulo Cataniag; Jed Noel Ong; Rosalia Teleg; Anthony Piano; Carmina Charmaine Bernardo; Rachelle Holandez; Jean Quint Oropilla; Cid Czarina Diesta

doi:10.1055/s-0045-1811606

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1811606

Case Report

Transient Perioperative Aggressive Behavior during Subthalamic Nucleus Deep Brain Stimulation for Parkinson's disease

Paulo Cataniag

¹Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines

²Department of Neurosciences, Baguio General Hospital and Medical Center, Baguio City, Philippines

,

Jed Noel Ong

¹Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines

,

Rosalia Teleg

¹Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines

⁴Cardinal Santos Medical Center, San Juan City, Metro Manila, Philippines

⁵University of the Philippines, Philippine General Hospital, Manila, Philippines

,

Anthony Piano

³Asian Brain Institute, Asian Hospital and Medical Center Muntinlupa City, Philippines

,

Carmina Charmaine Bernardo

¹Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines

,

Rachelle Holandez

¹Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines

,

Jean Quint Oropilla

¹Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines

³Asian Brain Institute, Asian Hospital and Medical Center Muntinlupa City, Philippines

,

Cid Czarina Diesta

¹Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines

³Asian Brain Institute, Asian Hospital and Medical Center Muntinlupa City, Philippines

› Author Affiliations

Abstract

Deep brain stimulation of subthalamic nucleus (STN-DBS) is recognized as the gold standard for symptomatic treatment of advanced Parkinson's disease (PD). However, despite adherence to screening protocol, perioperative neuropsychiatric complications are increasingly being recognized. The rapid development of psychiatric symptoms within less than 24 hours is rare, and acute episodes occurring during surgery are uncommon. We present a 57-year-old female patient diagnosed with PD, with good premorbid personality. However, mild depression was detected on neuropsychological assessment. After thorough deliberation and family meeting, patient was cleared to undergo STN-DBS as the expected benefits outweighed the potential risks. Intraoperatively, during microstimulation of the left STN, patient developed sudden onset of aggressive behavior. The behavioral change lessened when the DBS lead location was adjusted to a more lateral location. The psychiatric symptoms were then controlled with quetiapine until the behavioral changes had resolved after 7 days. No recurrence was noted during follow-up consults.This case report confirms the importance of fundamental knowledge and understanding of the neuroanatomical structures affected in DBS of the STN, and their clinical implications. A thorough preoperative psychiatric evaluation is essential for comprehensive management and allows anticipation of possible adverse events.

Keywords

Parkinson's disease - deep brain stimulation - subthalamic nucleus - psychiatric complication

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References

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