Objective: Deep brain stimulation (DBS) in Parkinson’s disease (PD) has been proven successful; however, not in all.

Background: We report on 5 PD patients who were unhappy after DBS, although doctors report considerable amelioration.

Methods: Patient (P) 1: 49-years-old (yo) male (m), PD 8 years (y), living alone and on social relief. He has emergency treatments due to “akinetic crises” correspondeing to panic attacks. Postoperatively he still presented with a mixed depressive-anxious disorder. P 2: 65 yo retired m, PD 12 y, with an extensive dependent personality disturbance and regressive tendencies in his marital relationship. Although no evidence of motor fluctuations after DBS, the patient could not walk, as he did before. Preoperative psychological testing had shown dissimulating and regressive tendencies, while secondary profit from PD had ceased. P 3: 63 yo retired m, PD 22 y. After DBS depressive phases, refrained from reduction of L-Dopa despite of hyperkinetic movements. Abuse of L-Dopa. Wife reported on request about impulse control disorders (hypersexuality via internet, compulsatory buying etc.) preoperatively. He showed very dissimulating tendencies, as the Parkinson’s disease Impulsive-Compulsive Disorders Questionnaire. (QUIP) was totally normal, although we diagnosed a L-Dopa-dysregulation-syndrome (DDS). P 4: 49 yo m, PD 4 y. Impulse control disorder (compulsive gambling, compulsive buying). After DBS and reduction of L-Dopa very unhappy despite good effect of DBS on fluctuations. Demands L-Dopa in immediate release form (Madopar LT) very often. Despite increased L-Dopa feels continuously in off phase and unhappy. DDS was diagnosed. P 5: 65 yo m, PD 13 y. After DBS reduction of L-Dopa, good movement, but subjectively in off phases. He took uncontrolled doses of Madopar LT, complaining at every time about being in off phase. Multiple changes of parameters of stimulation, nothing helped. He left rehabilitative care very unsatisfied and angry. DDS was diagnosed.

Results: We diagnosed DDS in three patients (P 3- 5), anxiety disorder (P1), and regressive behavior (P2). All patients were unhappy after DBS. A trait in all patients was dissimulation. Patient 3 knowingly gave wrong information in QUIP.

Conclusions: Every DDS-patient was denying L-Dopa-abuse, all were male. No one admitted L-Dopa addiction. A thorough examination of patients and caregivers are essential to prevent DBS from failing.

« Back to 2016 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/successful-dbs-doctors-happy-patients-not-why/