Abstract:
Objective:Stimulation-induced transient non-motor psychiatric symptom (SITNPS) was one of the side effects following bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson disease (PD) patients. The electrode contact inducing these psychiatric symptoms and the protocol to eliminate SITNPS with maintaining the optimal motor function were designed in this study, and the effectiveness of these algorithms was analyzed. Methods:All the PD patients who underwent programming sessions after STN-DBS implantations from January 1, 2015, to December 31, 2015, at the DBS programming clinic of Changhai Hospital were retrospectively analyzed. Only patients who were diagnosed with SITNPS were enrolled in this study. In these patients, the electrode contact inducing SITNPS was found and the programming protocol algorithms were used. The unified Parkinson disease rating scale part Ⅲ (UPDRS-Ⅲ) score was assessed with non-blinded method to analyze the motor functions before and after programming. Results:There were 1 287 patients-time enrolled in this study, and 11 patients were diagnosed with SITNPS of totally 20 times. Among these patients, 2 cases had 4 episodes of crying, 2 cases had 4 episodes of mirthful laughter, 1 case had 2 episodes of abnormal sense of spatial orientation, 1 case had 2 episodes of hallucination and 5 cases had 8 episodes of hypomania. After programming sessions, the mental symptoms in 10 patients were disappeared and the motor functions were maintained or better compared with SITNPS. In 1 patient, the motor and non-motor symptoms occurred alternately, at last, the UPDRS-Ⅲ score was decreased by 2 scores after stimulus parameter setting. There was no statistical difference of UPDRS-Ⅲ score before and after final stimulation parameter setting (without SITNPS) in 11 cases ([26.45±10.59] vs [26.45±10.17],P=1.000). Conclusions:The flow diagram in this study is helpful for determining electrode contact inducing SITNPS in PD patients, and the modified programming protocol employed in treatment of these symptoms is effective to make SITNPS disappear, without influencing the curative effect on motor function.