Social adjustment after neurosurgery in PD patients

A study report in Neurology describes problems with social adjustment, including difficulties with personal, marital and professional relationships, after subthalamic nucleus (STN) stimulation for Parkinson disease (PD).The French study prospectively examined aspects of social maladjustment experienced by 29 patients with PD before and 18 to 24 months after bilateral STN stimulation. The results showed that STN stimulation resulted in marked improvement in parkinsonian motor disability, no significant changes in cognitive status, and improvement of activities of daily living and quality of life. However, results of interviews exploring patients' professional and personal relationships showed that eight patients (28%) improved, 10 (34%) did not change, and 11 (38%) worsened in their social adjustment over the study period. The authors say that it was not possible to predict the outcome in individual patients, but social adaptation before surgery correlated with social adaptation at follow-up.Commenting on specific aspects of relationship changes after the operation, the authors report, "Financial situation, social life, relations with their children, and family life improved more often than they worsened. Marital life and professional activity, however, worsened more often than they improved". Marital conflicts occurred in 17 of 24 couples, and only 9 out of 16 patients who had worked professionally before the surgery went back to work afterwards. A feeling of strangeness, loss of vitality and a loss of aim in life were also commonly experienced among the patients.The authors illustrate the significant problems some patients faced via three case reports. Each patient was under 50 years of age, and each experienced major improvements in motor function after the operation. However, the patients' behaviour subtly changed after the operation, resulting in changes in marital and family relationships and difficulties at work. The authors conclude that the operation can result in poor social adjustment. "Whether this is a purely reactive response to a new situation or whether it is caused by an effect of STN stimulation on behavior, or both, remains to be elucidated," they say. They suggest a multidisciplinary approach to psychologically prepare patients for the changes after the operation. Reference...