Background: In primary dystonia patients (PTD), along with motor symptoms neuropsychiatric changes are often found. Abnormalities of mood and behavior contribute a lot to decrease in quality of life.
Objective: To reveal neuropsychiatric abnormalities in PTD and to trace their evolution following pallidal deep brain stimulation.
Methods: We assessed 62 patients operated for bilateral GPi-DBS: 16 patients with pharmaco-resistant cervical, 22 patients with segmental, and 24 patients with generalized PTD. Mean age at surgery was 41.7 ± 13.7 years; mean disease duration was 13.1 ± 11.7 years. Quantitative neuropsychiatric testing was performed prior to surgery and at 3, 6, and 12 months following GPi-DBS. For assessment of anxiety we used Spilberger scale; for depression — Beck inventory (BDI); for obsessive–compulsive disorder — Goodman screening test; for impulsivity — Barratt scale; for apathy — Starkstein scale; for hypomania symptoms — checklist HCL-32; for quality of life — SF-36 questionnaire.
Results: 61.3% of PTD patients had primarily elevated personal anxiety score, reactive anxiety was increased only in 21.0%. 51.6% of patients suffered moderate to severe depression. In 24.2%, obsessive–compulsive behavior was a considerable issue. 17.7% of patients had pathological impulsivity, 29.0% had apathy. In the course of GPi-DBS, depression scores significantly decreased (p < 0.01). From the 6th month of follow-up, reactive anxiety reduced (p < 0.05). Personal anxiety changed insignificantly. OCD-symptoms ameliorated (p < 0.05), however, apathy features showed increment. Impulsivity was not significantly influenced. Tendency to hypomanic shift was observed. Altogether, improvement in physical component of health following GPi-DBS was more pronounced than in mental component (SF-36).
Conclusions: In PTD, neuropsychiatric changes are frequent. GPi-DBS is safe for neuropsychiatric profile of patients. Moreover, GPi-DBS might lead to some extent of functional improvement in mood and behavior. Nevertheless, mental component of health seems not to be normalized.
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© 2015 Published by Elsevier Inc.
