Acute Neuropsychiatric Symptoms and Impulse Control Disorders After Subthalamic Nucleus Deep Brain Stimulation

Neuropsychiatric symptoms, including impulse control disorders and mood changes, are common nonmotor features across all Parkinson disease (PD) stages. Subthalamic nucleus (STN) deep brain stimulation (DBS) is a safe and well-established treatment for the management of refractory motor fluctuations in PD; however, it has been associated with worsening neuropsychiatric symptoms in the short and long term. Recognizing the occurrence of stimulation-induced behavioral symptoms is critical to implement effective and timely treatment. Most reports indicate that stimulation of the ventral and medial region within the STN and surrounding structures, including the substantia nigra, might account for the occurrence of acute impulsive behaviors and hypomania, requiring adopting different programming strategies aimed at limiting behavioral side effects while reducing parkinsonism. Stimulation of the most dorsal and lateral contacts can mitigate behavioral side effects after STN DBS, but specific treatment needs to be applied based on the patient’s individual neuropsychiatric and motor presentations and specific imaging-based brain localization of DBS lead contacts.