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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1811606
Case Report

Transient Perioperative Aggressive Behavior during Subthalamic Nucleus Deep Brain Stimulation for Parkinson's disease

Authors

  • Paulo Cataniag 

    1   Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines
    2   Department of Neurosciences, Baguio General Hospital and Medical Center, Baguio City, Philippines

  • Jed Noel Ong 

    1   Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines

  • Rosalia Teleg

    1   Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines
    4   Cardinal Santos Medical Center, San Juan City, Metro Manila, Philippines
    5   University of the Philippines, Philippine General Hospital, Manila, Philippines

  • Anthony Piano

    3   Asian Brain Institute, Asian Hospital and Medical Center Muntinlupa City, Philippines

  • Carmina Charmaine Bernardo

    1   Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines

  • Rachelle Holandez

    1   Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines

  • Jean Quint Oropilla

    1   Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines
    3   Asian Brain Institute, Asian Hospital and Medical Center Muntinlupa City, Philippines

  • Cid Czarina Diesta

    1   Movement Disorders Clinic, MakatiMed Institute of Neurological, Neurosurgical and Behavioral Sciences (M.I.N.D.S.), Makati City, Philippines
    3   Asian Brain Institute, Asian Hospital and Medical Center Muntinlupa City, Philippines
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Abstract

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.

Keywords

Parkinson's disease - deep brain stimulation - subthalamic nucleus - psychiatric complication

Authors' Contributions

P.C. contributed to the conception, organization, and execution of the research project and drafted the first version of the manuscript. J.N.O. participated in the conception, organization, and execution of the research project and critically reviewed the manuscript. R.T., A.P., C.C.B., and R.H. contributed to the critical review of the manuscript. J.Q.O. was involved in the conception, organization, and execution of the research project and critically reviewed the manuscript. C.C.D. contributed to the conception, organization, and execution of the research project and also reviewed the manuscript critically.


Ethical Approval

This case report was conducted in accordance with ethical standards and was approved by the Institutional Review Board of Makati Medical Center (MMCIRB2025–05–77-EXEMPTED). Patient consent was obtained for publication of this case report.




Publication History

Article published online:
25 September 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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