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Psychosocial adjustment after deep brain stimulation in Parkinson's disease

Nature Clinical Practice Neurology volume 4, pages 58–59 (2008)Cite this article

Since its first description in 1817, Parkinson's disease (PD) has been viewed mainly as a motor disorder; since the 1970s, neuropsychological abnormalities have been taken into account. Recently, the attention of clinicians has been drawn to behavioral symptoms in medically treated patients. Behavioral problems were also observed following the introduction of high-frequency stimulation of the subthalamic nucleus (STN) as a therapy for PD. First used in 1993, this surgical procedure has now been performed in over 40,000 patients worldwide. STN stimulation results in spectacular motor improvement of patients, provided that selection criteria are applied rigorously.1 Although there are no detrimental effects on cognition in patients carefully chosen for this surgery,2 subtle neuropsychological changes have been found in refined testing,3,4 and, unexpectedly, some patients have psychiatric symptoms following surgery.4 In spite of dramatic improvement in motor function, activities of daily living and even disease-related quality of life in most patients,5 clinicians are surprised to find that many of those who have undergone successful operation are not happier with their lives, go through tormented periods in their marriages, or fail to resume professional activity after surgery.6 How can one explain the relative lack of success of the operation on a personal ('self'), familial ('the other') and socio-professional ('the others') level, given the patients' recovery of normal motor function?

In a recent study,6 we were able to identify several contributory factors to problems in personal, familial and socio-professional adjustment. As far as the repercussions of neurosurgery on a patient's sense of self are concerned, six contributory factors can be evidenced. After the temporary euphoria following the operation, some patients have difficulty in adopting a new self-image (“I don't seem to recognize myself without the problems I had before”). For some who had spent years fighting against the malady, concomitant with the sudden improvement there is a loss of an aim in life, as if life had lost all meaning (“there's no longer anything to fight against; my life seems empty”). Some patients cannot cope with the damage that PD has done previously; looking back at the disaster the disease has caused in their lives, they feel lost and distressed in a 'repaired body'. Others show a persistent negative anticipation of the problems that the disease used to cause before the operation and have to be trained to a life with less disability (“my body is cured, but my mind is still sick”). Still others complain of a loss of vital force ('élan vital') and become apathetic, an observation that has also been described by other authors.7 Finally, the incorporation of the implanted device into the body image poses problems for some patients, who feel alienated from themselves because of a pacemaker acting on their brains (“I feel like a Robocop”).

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Author notes

  1. Y Agid is Professor of Neurology and Director of Neurosciences at the Pitié-Salpêtrière University Hospital, Paris, France.

Authors and Affiliations

  1. WMM Schüpbach is a Clinical Neurologist at the Pitié-Salpêtrière University Hospital, Paris, France, and at Bern University Hospital, Bern, Switzerland.,

    WM Michael Schüpbach & Yves Agid

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  1. WM Michael Schüpbach
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  2. Yves Agid
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Correspondence to Yves Agid.

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Schüpbach, W., Agid, Y. Psychosocial adjustment after deep brain stimulation in Parkinson's disease. Nat Rev Neurol 4, 58–59 (2008). https://doi.org/10.1038/ncpneuro0714

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