GMS | 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC) 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie | Alterations of sociomoral judgement and glucose utilization in the frontomedial cortex induced by electrical stimulation of the subthalamic nucleus (STN) in Parkinsonian patients
- ️Brentrup A, Ohrmann P, Weckesser M, Tombach B, Bothe HW
Text
Objective
Appearance of behavioural and psychiatric disorders after high frequency stimulation of the subthalamic nucleus (STN) was reported in 1 of 10 Parkinsonian patients. We analyzed personality traits and sociomoral judgement in correlation to glucose utilization in the frontal cortex of STN stimulated patients suffering from Parkinson´s disease.
Methods
2 of 15 patients with Parkinson´s disease (both male, 45 and 51 years old) and bilateral STN stimulation showed social maladjustment with persistency of 1 year after electrode implantation. We investigated motor function by the UPDRS scale, personality traits by NEO-FFI, sociomoral judgement applying the Kohlberg test, and glucose utilization of the brain using positron emission tomography. Parameters were assessed 1 year after implantation with the stimulation switched both ON and OFF.
Results
Motor disability was ameliorated by about 70 % in both patients and the levodopa equivalent daily dosage was reduced by 55% and 50%, respectively. With stimulation switched ON personality traits showed an increase of novelty seeking (from 1.50 to 2.25, normal range 2.21 - 3.18) and a decrease of conscientiousness (from 2.41 to 1.66, normal range 1.94 - 3.18). Sociomoral judgement decreased during stimulation switched ON from normal level 4 (adhering to social system and conscience) to level 2 (serving one´s own interests and letting others do the same). Glucose utilization of frontomedial cortex increased significantly when stimulation of STN was switched ON.
Conclusions
STN stimulation causes deterioration of sociomoral judgement in association with changes of personality traits in some Parkinsonian patients. In those patients glucose metabolism of the frontomedial cortex increases. These alterations may explain the social maladjustment in some patients with STN stimulation.