“My family say they grieve for the old me” – profound personality changes after deep brain stimulation

Okun (2012).New England Journal of Medicine.Deep brain stimulation (DBS) of the subthalamic nucleus inParkinson ' s disease (PD) has been highly successful in controlling the motor symptoms of this disorder, which include tremor, slowed movement (akinesia), and muscle stiffness or rigidity. The figure above shows the electrode implantation procedure for PD, where a stimulating electrode is placed in either thesubthalamic nucleus, (STN), a tiny collection of neurons within the basal ganglia circuit, or in the internal segment of theglobus pallidus, another structure in the basal ganglia (Okun, 2012). DBS of the STN is more common, and more often a source of disturbing non-motor side effects.In brief, DBS of the STN alters neural activity patterns in complex cortico-basal-ganglia-thalamo-cortical networks (McIntyre& Hahn, 2010).DBS surgery may be recommended for some patients in whom dopamine (DA) replacement therapy has become ineffective, usually after a few years. DA medications include the classic DA precursor L-DOPA, followed byDA agonists such as pramipexole, ropinirole, and bromocriptine. But unfortunately, impulse control disorders (ICDs, e.g., compulsive shopping, excessive gambling, binge eating, and compulsive sexual behavior) occur in about 17% of PD patients on DA agonists (Voon et al., 2017).There are many first-person accounts from PD patients who describe uncharacteristic and embarrassing behavior after taking DA agonists, like this grandpa who started seein...

Source: The Neurocritic - May 13, 2018 Category: Neuroscience Authors: The Neurocritic Source Type: blogs