Limbic Stimulation Drives Mania in <scp>STN‐DBS</scp> in Parkinson Disease: A Prospective Study
Stéphane Prange, Zhengyu Lin, Mikaïl Nourredine, Téodor Danaila, Chloé Laurencin, Ouhaïd Lagha‐Boukbiza, Mathieu Anheim, Hélène Klinger, Nadine Longato, Clélie Phillipps, Jimmy Voirin, Gustavo Polo, Émile Simon, Patrick Mertens, Anne‐Sophie Rolland, David Devos, Élise Météreau, Christine Tranchant, Stéphane Thobois, for the Predistim study group
Abstract
In this one-year prospective study, Parkinson's disease (PD) patients with or without mania following STN-DBS were compared to investigate risk and etiological factors, clinical management and consequences. Eighteen (16.2%) out of 111 consecutive PD patients developed mania, of whom 17 were males. No preoperative risk factor was identified. Postoperative mania was related to ventral limbic subthalamic stimulation in 15 (83%) patients, and resolved as stimulation was relocated to the sensorimotor STN, besides discontinuation or reduction of dopamine agonists and use of low-dose clozapine in 12 patients, while motor and nonmotor outcomes were similar. These findings underpin the prominent role of limbic subthalamic stimulation in postoperative mania. ANN NEUROL 2022;92:411-417.