Objective: To describe the diagnosis and management of deep brain stimulation-induced elevated mood states.

Background: Deep brain stimulation (DBS) is an FDA-approved surgical treatment option for movement disorders including dystonia, essential tremor, and Parkinson’s disease (PD). Subthalamic nucleus (STN) DBS has been linked to rare but potential psychiatric complications, warranting a thorough preoperative evaluation and risk assessment. DBS-associated psychiatric complications can include mood lability, elevated mood states, irritability, depression, impulsivity, suicidal ideation or behavior, and psychosis. DBS-induced elevated mood states (previously described as mania/hypomania or “mirthful laughter”) can pose diagnostic and treatment challenges [1].

Method: Three advanced male PD patients experiencing motor fluctuations and treated with STN DBS all experienced clear STN DBS-induced mood elevated states after adjustments to the DBS programming settings.

Results: Mood elevation presented as impulsivity, psychomotor agitation, irritability, rapid speech, and lack of empathy. Two of the patients had an impulse control disorder before DBS surgery. Elevated mood occurred acutely after crossing a “stimulation” threshold (usually using monopolar stimulation mode) and was reproducible. Management strategies included reduction of stimulation amplitude, reprogramming, and elimination of amantadine. Reverting to previous settings resulted in re-emergence of these behaviors.

Conclusion: Appropriate diagnosis and management of these rare patients experiencing DBS-induced elevated mood state is complex and best handled by a multidisciplinary team.  Risk factors may include – previous history of ICD and family history of Bipolar Disorder. Management strategies include DBS setting adjustments, behavioral strategies, and mood stabilizers which typically result in resolution of these symptoms [1,2].

References: 1. Wu X, Qiu Y, Simfukwe K, et al. Programming for Stimulation-Induced Transient Nonmotor Psychiatric Symptoms after Bilateral Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s Disease. Parkinsons Dis 2017;2017:2615619 2. Seritan AL, Ureste PJ, Duong T, Ostrem JL. Psychopharmacology for patients with Parkinson’s disease and deep brain stimulation: Lessons learned in an academic center. Curr Psychopharmacol 2019;8:41-54.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/diagnosis-and-management-strategies-used-in-series-of-parkinsons-disease-patients-who-experienced-subthalamic-nucleus-deep-brain-stimulation-induced-mood-elevation/