Mood and behavioural effects of subthalamic stimulation in Parkinson's disease

Lancet Neurol. 2014 Mar;13(3):287-305. doi: 10.1016/S1474-4422(13)70294-1. Epub 2014 Feb 17.


Deep-brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for motor complications in Parkinson's disease. 20 years of experience with this procedure have contributed to improved understanding of the role of the STN in motor, cognitive, and emotional control. In Parkinson's disease, the pathological STN neuronal activity leads to motor, cognitive, and emotional inhibition. Deafferentation of the STN by DBS can reverse such behavioural inhibition. The release of this brake allows both motor and non-motor improvement, but can also be associated with excessive motor, cognitive, and emotional behavioural disinhibition. Conversely, the notable reduction in anti-parkinsonian drug dose allowed by motor improvement can unveil mesolimbic hypodopaminergic behaviours such as apathy, anxiety, or depression. Fine-tuning of stimulation parameters with dopaminergic drugs is necessary to prevent or improve pathological behaviours.

Publication types

  • Review

MeSH terms

  • Affect / physiology*
  • Behavioral Symptoms / diagnosis
  • Behavioral Symptoms / etiology
  • Behavioral Symptoms / psychology*
  • Deep Brain Stimulation / adverse effects
  • Deep Brain Stimulation / methods*
  • Humans
  • Mental Disorders / diagnosis
  • Mental Disorders / etiology
  • Mental Disorders / psychology*
  • Parkinson Disease / physiopathology
  • Parkinson Disease / psychology*
  • Parkinson Disease / therapy
  • Randomized Controlled Trials as Topic / methods
  • Subthalamic Nucleus / physiology*