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Neurosurgery in Parkinson disease

A distressed mind in a repaired body?

From the Centre d’Investigation Clinique (M.S., M.G., M.L.W., L.M., C.B., Y.A.), Fédération des Maladies du Système Nerveux, INSERM U679, Université Paris VI, CHU Pitié-Salpêtrière, Paris; Clinique de Neurologie (J.L.H., V.M.), CHU Poitiers; and Clinique de Neurologie (D.M.), CHU Rouen, France.

Address correspondence and reprint requests to Dr. Y. Agid, Centre d’Investigation Clinique, Hôpital de la Salpêtrière, 47 boulevard de l’Hôpital, 75013 Paris, France; e-mail: agid{at}ccr.jussieu.fr

Objective: To prospectively evaluate the impact of subthalamic nucleus (STN) stimulation on social adjustment in patients with Parkinson disease (PD).

Methods: Before and 18 to 24 months after bilateral STN stimulation, the authors assessed 29 patients with PD for motor disability, cognition (Mattis dementia rating scale, frontal score), psychiatric morbidity (Mini-5.0.0, MADRS, BAS), quality of life (PDQ-39), social adjustment (Social Adjustment Scale), and psychological status using unstructured in-depth interviews.

Results: Despite marked improvement in parkinsonian motor disability, the absence of significant changes in cognitive status, and improvement of activities of daily living and quality of life by the end of the study, social adjustment did not improve. Several kinds of problems with social adjustment were observed, affecting the patients’ perception of themselves and their body, marital situation, and professional life. Marital conflicts occurred in 17/24 couples. Only 9 out of 16 patients who had a professional activity before the operation went back to work after surgery.

Conclusion: After STN stimulation, patients experienced difficulties in their relations with themselves, their spouses, their families, and their socio-professional environment. The authors suggest a multidisciplinary psychosocial preparation and follow-up to help patients and their entourage cope with the sudden changes in their existence following successful neurosurgery.

Editorial, see page 1799

See also page 1830

*These authors contributed equally to the article.

Supported by grants from the Swiss National Science Foundation and the Swiss PD Association (M.S.).

Disclosure: The authors report no conflicts of interest.

Received October 31, 2005. Accepted in final form April 4, 2006.

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