Neuropsychological, neuropsychiatric, and quality of life issues in DBS for dystonia

• Published in: Movement disorders Vol. 26; no. S1; pp. S63 - S78
• Main Authors: Jahanshahi, Marjan, Czernecki, Virginie, Zurowski, and Mateusz
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-06-2011; Wiley Subscription Services, Inc
• Subjects: cognition; Cognition Disorders - etiology; Cognition Disorders - therapy; DBS; Deep Brain Stimulation - adverse effects; Deep Brain Stimulation - methods; dystonia; Dystonia - complications; Dystonia - psychology; Dystonia - therapy; Globus Pallidus - physiology; Humans; Mental Disorders - etiology; Mental Disorders - therapy; Movement disorders; Neuropsychological Tests; psychiatric quality of life; Quality of Life - psychology; Severity of Illness Index; surgery
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.23511

We review the impact of dystonia and its surgical treatment with deep brain stimulation (DBS) on cognitive function, psychiatric morbidity, and health‐related quality of life. The current evidence suggests that globus pallidus internus (GPi) DBS does not cause cognitive decline in primary dystonia. However, we recommend general preoperative screening of cognition in patients with dystonia to evaluate baseline cognitive status and monitor for possible postoperative changes. Patients with mild to moderate depression appear to do well postoperatively; however, there are scant data about those with severe depression. This is particularly problematic given reports of postoperative suicide. Patients with tardive dystonia seem to do well post‐GPi DBS despite often having a history of depression or even having active severe depression. We make recommendations for screening and basic management strategies of patients identified as having a major psychiatric illness pre‐ or postoperatively. Quality of life in dystonia patients quantified by generic measures such as the SF36 showed improvement in both mental and physical categories following DBS surgery. © 2011 Movement Disorder Society