Transient Perioperative Aggressive Behavior during Subthalamic Nucleus Deep Brain
Stimulation for Parkinson s disease
#MMPMID41340770
Cataniag P
; Ong JN
; Teleg R
; Piano A
; Bernardo CC
; Holandez R
; Oropilla JQ
; Diesta CC
Asian J Neurosurg
2025[Dec]; 20
(4
): 883-887
PMID41340770
show ga
Deep brain stimulation of subthalamic nucleus (STN-DBS) is recognized as the gold
standard for symptomatic treatment of advanced Parkinson's disease (PD). However,
despite adherence to screening protocol, perioperative neuropsychiatric
complications are increasingly being recognized. The rapid development of
psychiatric symptoms within less than 24?hours is rare, and acute episodes
occurring during surgery are uncommon. We present a 57-year-old female patient
diagnosed with PD, with good premorbid personality. However, mild depression was
detected on neuropsychological assessment. After thorough deliberation and family
meeting, patient was cleared to undergo STN-DBS as the expected benefits
outweighed the potential risks. Intraoperatively, during microstimulation of the
left STN, patient developed sudden onset of aggressive behavior. The behavioral
change lessened when the DBS lead location was adjusted to a more lateral
location. The psychiatric symptoms were then controlled with quetiapine until the
behavioral changes had resolved after 7 days. No recurrence was noted during
follow-up consults.This case report confirms the importance of fundamental
knowledge and understanding of the neuroanatomical structures affected in DBS of
the STN, and their clinical implications. A thorough preoperative psychiatric
evaluation is essential for comprehensive management and allows anticipation of
possible adverse events.
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