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Post of the Week: Mania and DBS may Depend on Where you Stimulate


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#1 Dr. Okun

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Posted 07 November 2010 - 10:16 AM

Dear forum members,

One of the potential side effects of DBS therapy is inducing a very positive mood state referred to as mania. These authors examined where DBS leads were located in patients that got "manic" and the majority were stimulated off of deep contacts in the substantia nigra region. If this side effect is encountered you should seek medical attention immediately either for reprogramming or for changes in medicine (mood stabilizers). Here is the abstract below:

J Neurol Neurosurg Psychiatry. 2010 Nov 3. [Epub ahead of print]
Contact dependent reproducible hypomania induced by deep brain stimulation in Parkinson's disease: clinical, anatomical and functional imaging study.
Ulla M, Thobois S, Llorca PM, Derost P, Lemaire JJ, Chereau-Boudet I, de Chazeron I, Schmitt A, Ballanger B, Broussolle E, Durif F.

CHU Clermont-Ferrand, Service de Neurologie A, Clermont-Ferrand, France.
Abstract
Hypomanic symptoms depending on anatomical location of contacts are reported in patients with Parkinson's disease (PD) treated by deep brain stimulation (DBS) of the subthalamic nucleus (STN). However, the underlying cortical and subcortical dysfunction is debated. In this study, five PD patients implanted with DBS-STN who presented with reversible and reproducible hypomanic symptoms after stimulation of specific 'manic' contacts were investigated. Hypomanic symptoms were assessed using the Bech and Rafaelsen Mania Scale (MAS). Three dimensional anatomical location of 'euthymic' and 'manic' contacts, after matching the postoperative CT scan with the preoperative stereotactic MRI, and a H(2)(15)O positron emission tomography (PET) study testing 'euthymic' and 'manic' contacts, were performed. Under 'euthymic' conditions, MAS score (mean±SD) was 0.6±0.5 compared with 7.8±3.1 under 'manic' conditions. Nine of 10 'manic' contacts were located in the substantia nigra, mainly in its ventral part. PET showed that hypomania was associated with strong asymmetrical cerebral activation involving preferentially the right hemisphere and was mediated by activation of the anterior cingulate and medial prefrontal cortex. The present study demonstrates the role of the subcortical structures in the genesis of hypomania in PD patients treated with DBS and stresses the involvement of the substantia nigra.

PMID: 21047882 [PubMed - as supplied by publisher]

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#2 Pennypims

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Posted 25 February 2011 - 01:49 PM

Dear forum members,

One of the potential side effects of DBS therapy is inducing a very positive mood state referred to as mania. These authors examined where DBS leads were located in patients that got "manic" and the majority were stimulated off of deep contacts in the substantia nigra region. If this side effect is encountered you should seek medical attention immediately either for reprogramming or for changes in medicine (mood stabilizers). Here is the abstract below:

J Neurol Neurosurg Psychiatry. 2010 Nov 3. [Epub ahead of print]
Contact dependent reproducible hypomania induced by deep brain stimulation in Parkinson's disease: clinical, anatomical and functional imaging study.
Ulla M, Thobois S, Llorca PM, Derost P, Lemaire JJ, Chereau-Boudet I, de Chazeron I, Schmitt A, Ballanger B, Broussolle E, Durif F.

CHU Clermont-Ferrand, Service de Neurologie A, Clermont-Ferrand, France.
Abstract
Hypomanic symptoms depending on anatomical location of contacts are reported in patients with Parkinson's disease (PD) treated by deep brain stimulation (DBS) of the subthalamic nucleus (STN). However, the underlying cortical and subcortical dysfunction is debated. In this study, five PD patients implanted with DBS-STN who presented with reversible and reproducible hypomanic symptoms after stimulation of specific 'manic' contacts were investigated. Hypomanic symptoms were assessed using the Bech and Rafaelsen Mania Scale (MAS). Three dimensional anatomical location of 'euthymic' and 'manic' contacts, after matching the postoperative CT scan with the preoperative stereotactic MRI, and a H(2)(15)O positron emission tomography (PET) study testing 'euthymic' and 'manic' contacts, were performed. Under 'euthymic' conditions, MAS score (mean±SD) was 0.6±0.5 compared with 7.8±3.1 under 'manic' conditions. Nine of 10 'manic' contacts were located in the substantia nigra, mainly in its ventral part. PET showed that hypomania was associated with strong asymmetrical cerebral activation involving preferentially the right hemisphere and was mediated by activation of the anterior cingulate and medial prefrontal cortex. The present study demonstrates the role of the subcortical structures in the genesis of hypomania in PD patients treated with DBS and stresses the involvement of the substantia nigra.

PMID: 21047882 [PubMed - as supplied by publisher]



I am Bipolar as well as having PD. Would this make me a poor candidate for DBS?

#3 Dr. Okun

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Posted 26 February 2011 - 12:48 PM

It is just one more factor to consider but being bipolar does not eliminate you from surgery.

Now, if you were ever deemed a DBS candidate you would need to watch out for post-op mania.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips





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