Aktuelle Neurologie 2007; 34 - V223
DOI: 10.1055/s-2007-987557

Neuropsychological and psychiatric sequelae of deep-brain stimulation for Parkinson's disease – a randomized, controlled, multicenter study

C Daniels 1, K Witt 1, J Reiff 1, P Krack 1, M Krause 1, K Boetzel 1, A Schnitzler 1, L Wojtecki 1, R Hilker 1, E Kalbe 1, GH Schneider 1, A Kupsch 1, G Deuschl 1
  • 1XXfor the German Parkinson Study Group, Neurostimulation Section

Objective: To evaluate the neuropsychological and psychiatric effects of bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) compared to optimized medical treatment in advanced Parkinson s disease (PD) in a randomized controlled study.

Background: STN-DBS markedly reduces parkinsonian symptoms in patients with advanced Parkinson s disease and leads to a significant improvement of quality of life. Two controlled studies on the neuropsychological effects of STN-DBS reported a mild deterioration of attention and executive functioning, but in both studies no randomization between surgery and best medical treatment was performed.

Methods: 134 pairwise randomized patients from the Randomized trial of deep brain stimulation for Parkinson s disease (1) underwent neuropsychological and psychiatric examinations to evaluate the changes from baseline to six month after STN-DBS or optimized medical treatment.

Results: The STN-DBS group showed a significant decline in verbal fluency and the Stroop test. All other neuropsychological tests and the psychiatric scales did not reveal significant differences between the STN-DBS group and the medication group. However, adverse events associated to neuropsychological or psychiatric symptoms were more frequent in the STN-DBS group.

Conclusions: This is the first randomized controlled study evaluating neuropsychological and psychiatric sequelae of STN-DBS. STN-DBS seems to be relatively safe concerning neuropsychological and psychiatric side effects in carefully selected patients.

The decline of executive functioning is in line with the findings of previous studies. However, the implications of the decline in executive functioning after STN-DBS for daily life still need to be investigated in detail.

The evaluation of mood and overall psychiatric functioning did not reveal significant changes on group level, though patients with STN-DBS more frequently developed neuropsychological or psychiatric symptoms.

1 Deuschl et al.. A randomized trial of deep-brain stimulation for Parkinson s disease. N Engl J Med. 2006 Aug 31;355(9):896–908.