Objective: To investigate the incidence, risk and etiological factors, clinical management and consequences of mania following subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD).

Background: Mania is a distressing side effect of STN-DBS in Parkinson’s disease. However, no prospective study has evaluated its incidence, risk and etiological factors, clinical management and consequences.

Method: In this one-year prospective bicentric cohort, PD patients with or without mania following STN-DBS were compared to evaluate preoperative risk factors, relationship with stimulation contacts location and stimulation parameters, postoperative clinical management, and motor and nonmotor outcomes at one year after surgery.

Results: Eighteen (16.2%) out of 111 consecutive PD patients developed mania following STN-DBS, 17 of whom were males. No preoperative risk factor, notably neuropsychiatric disorders, was identified. Postoperative mania was related to the use of ventromedial contacts in 15 (83%) patients, and resolved within one month in 12 out of 18 patients as stimulation was relocated to the dorsal STN, besides discontinuation or reduction of dopamine agonists, and use of low-dose clozapine in 12 patients. Motor and nonmotor outcome at one year was similar in patients with or without postoperative mania.

Conclusion: Postoperative mania is primarily related to the stimulation of the limbic territory of the STN, but can be efficiently reversed while switching the stimulation to the sensorimotor territory, guaranteeing long-term motor and nonmotor benefits.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mania-induced-by-stn-dbs-is-related-to-the-stimulation-of-the-ventromedial-subthalamic-nucleus-in-parkinsons-disease-a-prospective-study/