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Changes in Personality Associated with Deep Brain Stimulation: a Qualitative Evaluation of Clinician Perspectives

  • Cassandra J. ThomsonEmail author
  • Rebecca A. Segrave
  • Adrian Carter


Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors (response to treatment, disease pathology, pharmacological changes) as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed.


Deep brain stimulation Personality Identity Self Neuroethics Surgical trials 


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  1. 1.
    Gilbert, F., J.N.M. Viaña, and C. Ineichen. 2018. Deflating the “DBS causes personality changes” bubble. Neuroethics 1–17.Google Scholar
  2. 2.
    Agid, Y., et al. 2006. Neurosurgery in Parkinson's disease: The doctor is happy, the patient less so? Journal of Neural Transmission. Supplementum 70: 409–414.Google Scholar
  3. 3.
    Schüpbach, W.M., et al. 2006. Neurosurgery in Parkinson disease: A distressed mind in a repaired body? Neurology 66 (12): 1811–1816.Google Scholar
  4. 4.
    Bittlinger, M. 2017. The patient's voice in DBS research: Advancing the discussion through methodological rigor. AJOB Neuroscience 8 (2): 118–120.Google Scholar
  5. 5.
    Müller, S., M. Bittlinger, and H. Walter. 2017. Threats to neurosurgical patients posed by the personal identity debate. Neuroethics 10 (2): 299–310.Google Scholar
  6. 6.
    Gilbert, F., E. Goddard, J.N.M. Viaña, A. Carter, and M. Horne. 2017. I miss being me: Phenomenological effects of deep brain stimulation. AJOB Neuroscience 8 (2): 96–109.Google Scholar
  7. 7.
    Christen, M., M. Bittlinger, H. Walter, P. Brugger, and S. Müller. 2012. Dealing with side effects of deep brain stimulation: Lessons learned from stimulating the STN. AJOB Neuroscience 3 (1): 37–43.Google Scholar
  8. 8.
    Synofzik, M. 2007. Intervening in the neural basis of one's personality: A practice-oriented ethical analysis of neuropharmacology and deep-brain stimulation. Deutsche Medizinische Wochenschrift 132 (50): 2711–2713.Google Scholar
  9. 9.
    Synofzik, M., and T.E. Schlaepfer. 2008. Stimulating personality: Ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes. Biotechnology Journal 3 (12): 1511–1520.Google Scholar
  10. 10.
    Glannon, W. 2009. Stimulating brains, altering minds. Journal of Medical Ethics 35 (5): 289–292.Google Scholar
  11. 11.
    Fassino, S., G. Abbate Daga, C. Gramaglia, A. Pierò, M. Zibetti, L. Castelli, A. Cinquepalmi, M. la Notte, and L. Lopiano. 2010. Novelty-seeking in Parkinson's disease after deep brain stimulation of the subthalamic nucleus: A case-control study. Psychosomatics 51 (1): 62–67.Google Scholar
  12. 12.
    Lewis, C.J., F. Maier, N. Horstkötter, A. Zywczok, K. Witt, C. Eggers, T.D. Meyer, T.A. Dembek, M. Maarouf, E. Moro, M. Zurowski, C. Woopen, J. Kuhn, and L. Timmermann. 2015. Subjectively perceived personality and mood changes associated with subthalamic stimulation in patients with Parkinson's disease. Psychological Medicine 45 (1): 73–85.Google Scholar
  13. 13.
    Lhommee, E., et al. 2017. Personality, dopamine, and Parkinson's disease: Insights from subthalamic stimulation. Movement Disorders 32 (8): 1191–1200.Google Scholar
  14. 14.
    Pham, U., et al. 2015. Personality changes after deep brain stimulation in Parkinson's disease. Parkinson's Disease 2015: 490507.Google Scholar
  15. 15.
    Christen, M., C. Ineichen, M. Bittlinger, H.W. Bothe, and S. Müller. 2014. Ethical focal points in the international practice of deep brain stimulation. AJOB Neuroscience 5 (4): 65–80.Google Scholar
  16. 16.
    Bell, E., B. Maxwell, M.P. McAndrews, A. Sadikot, and E. Racine. 2011. Deep brain stimulation and ethics: Perspectives from a multisite qualitative study of Canadian neurosurgical centers. World Neurosurgery 76 (6): 537–547.Google Scholar
  17. 17.
    Bell, E., and E. Racine. 2013. Clinical and ethical dimensions of an innovative approach for treating mental illness: A qualitative study of health care trainee perspectives on deep brain stimulation. Canadian Journal of Neuroscience Nursing 35 (3): 23–32.Google Scholar
  18. 18.
    Braun, V., and V. Clarke. 2006. Using thematic analysis in psychology. Qualitative Research in Psychology 3 (2): 77–101.Google Scholar
  19. 19.
    Schüpbach, W.M., et al. 2013. Neurostimulation for Parkinson's disease with early motor complications. New England Journal of Medicine 368 (7): 610–622.Google Scholar
  20. 20.
    Kumar, R.M., et al. 1998. Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease. Neurology 51 (3): 850–855.Google Scholar
  21. 21.
    Houeto, J.L., V. Mesnage, L. Mallet, B. Pillon, M. Gargiulo, S.T. du Moncel, A.M. Bonnet, B. Pidoux, D. Dormont, P. Cornu, and Y. Agid. 2002. Behavioural disorders, Parkinson's disease and subthalamic stimulation. Journal of Neurology, Neurosurgery, and Psychiatry 72 (6): 701–707.Google Scholar
  22. 22.
    Funkiewiez, A. 2004. Long term effects of bilateral subthalamic nucleus stimulation on cognitive function, mood, and behaviour in Parkinson's disease. Journal of Neurology, Neurosurgery & Psychiatry 75 (6): 834–839.Google Scholar
  23. 23.
    Krause, M., W. Fogel, A. Heck, W. Hacke, M. Bonsanto, C. Trenkwalder, and V. Tronnier. 2001. Deep brain stimulation for the treatment of Parkinson's disease: Subthalamic nucleus versus globus pallidus internus. Journal of Neurology, Neurosurgery, and Psychiatry 70 (4): 464–470.Google Scholar
  24. 24.
    Romito, L.M., M. Raja, A. Daniele, M.F. Contarino, A.R. Bentivoglio, A. Barbier, M. Scerrati, and A. Albanese. 2002. Transient mania with hypersexuality after surgery for high frequency stimulation of the subthalamic nucleus in Parkinson's disease. Movement Disorders 17 (6): 1371–1374.Google Scholar
  25. 25.
    Krack, P., R. Kumar, C. Ardouin, P.L. Dowsey, J.M. McVicker, A.L. Benabid, and P. Pollak. 2001. Mirthful laughter induced by subthalamic nucleus stimulation. Movement Disorders 16 (5): 867–875.Google Scholar
  26. 26.
    Mosley, P.E., D. Smith, T. Coyne, P. Silburn, M. Breakspear, and A. Perry. 2018. The site of stimulation moderates neuropsychiatric symptoms after subthalamic deep brain stimulation for Parkinson's disease. NeuroImage: Clinical 18: 996–1006.Google Scholar
  27. 27.
    Krack, P., A. Batir, N. van Blercom, S. Chabardes, V. Fraix, C. Ardouin, A. Koudsie, P.D. Limousin, A. Benazzouz, J.F. LeBas, A.L. Benabid, and P. Pollak. 2003. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. New England Journal of Medicine 349 (20): 1925–1934.Google Scholar
  28. 28.
    Herzog, J., J. Volkmann, P. Krack, F. Kopper, M. Pötter, D. Lorenz, M. Steinbach, S. Klebe, W. Hamel, B. Schrader, D. Weinert, D. Müller, H.M. Mehdorn, and G. Deuschl. 2003. Two-year follow-up of subthalamic deep brain stimulation in Parkinson's disease. Movement Disorders 18 (11): 1332–1337.Google Scholar
  29. 29.
    Voon, V., C. Kubu, P. Krack, J.L. Houeto, and A.I. Tröster. 2006. Deep brain stimulation: Neuropsychological and neuropsychiatric issues. Movement Disorders 21 (Suppl 14): S305–S327.Google Scholar
  30. 30.
    de Haan, S., E. Rietveld, M. Stokhof, and D. Denys. 2015. Effects of deep brain stimulation on the lived experience of obsessive-compulsive disorder patients: In-depth interviews with 18 patients. PLoS One 10 (8): e0135524.Google Scholar
  31. 31.
    Haq, I.U., K.D. Foote, W.K. Goodman, N. Ricciuti, H. Ward, A. Sudhyadhom, C.E. Jacobson, M.S. Siddiqui, and M.S. Okun. 2010. A case of mania following deep brain stimulation for obsessive compulsive disorder. Stereotactic and Functional Neurosurgery 88 (5): 322–328.Google Scholar
  32. 32.
    Mallet, L., M. Polosan, N. Jaafari, N. Baup, M.L. Welter, D. Fontaine, S.T. Montcel, J. Yelnik, I. Chéreau, C. Arbus, S. Raoul, B. Aouizerate, P. Damier, S. Chabardès, V. Czernecki, C. Ardouin, M.O. Krebs, E. Bardinet, P. Chaynes, P. Burbaud, P. Cornu, P. Derost, T. Bougerol, B. Bataille, V. Mattei, D. Dormont, B. Devaux, M. Vérin, J.L. Houeto, P. Pollak, A.L. Benabid, Y. Agid, P. Krack, B. Millet, and A. Pelissolo. 2008. Subthalamic nucleus stimulation in severe obsessive–compulsive disorder. New England Journal of Medicine 359 (20): 2121–2134.Google Scholar
  33. 33.
    Pugh, J., L. Pycroft, H. Maslen, T. Aziz, and J. Savulescu. 2018. Evidence-based Neuroethics, deep brain stimulation and personality - deflating, but not bursting, the bubble. Neuroethics 1–12.Google Scholar
  34. 34.
    Schüpbach, W.M., et al. 2014. Myths and facts about the EARLYSTIM study. Movement Disorders 29 (14): 1742–1750.Google Scholar
  35. 35.
    Pillon, B. 2002. Neuropsychological assessment for management of patients with deep brain stimulation. Movement Disorders 17 (S3): S116–S122.Google Scholar
  36. 36.
    Stout, J.C., R.E. Ready, J. Grace, P.F. Malloy, and J.S. Paulsen. 2003. Factor analysis of the frontal systems behavior scale (FrSBe). Assessment 10 (1): 79–85.Google Scholar
  37. 37.
    Denheyer, M., Z.H. Kiss, and A.M. Haffenden. 2009. Behavioral effects of subthalamic deep brain stimulation in Parkinson's disease. Neuropsychologia 47 (14): 3203–3209.Google Scholar
  38. 38.
    Barrash, J., D. Tranel, and S.W. Anderson. 2000. Acquired personality disturbances associated with bilateral damage to the ventromedial prefrontal region. Developmental Neuropsychology 18 (3): 355–381.Google Scholar
  39. 39.
    Cervone, D., and L.A. Pervin. 2015. Personality, binder ready version: theory and research. Wiley. United States.Google Scholar
  40. 40.
    Saint-Cyr, J.A., et al. 2000. Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease. Brain 123 (10): 2091–2108.Google Scholar
  41. 41.
    Boel, J.A., V.J.J. Odekerken, G.J. Geurtsen, B.A. Schmand, D.C. Cath, M. Figee, P. van den Munckhof, R.J. de Haan, P.R. Schuurman, R.M.A. de Bie, and the NSTAPS study group. 2016. Psychiatric and social outcome after deep brain stimulation for advanced Parkinson's disease. Movement Disorders 31 (3): 409–413.Google Scholar
  42. 42.
    Thomson, C., et al. 2019. Patients’ weighing of the long-term risks and consequences associated with deep brain stimulation in treatment-resistant depression. AJOB Neuroscience 9 (4): 243–245.Google Scholar
  43. 43.
    Mosley, P.E., et al. 2019 Woe betides anybody who tries to turn me down.’ A Qualitative Analysis of Neuropsychiatric Symptoms Following Subthalamic Deep Brain Stimulation for Parkinson’s Disease. Neuroethics 1–17.Google Scholar
  44. 44.
    Festinger, D.S., K.L. Dugosh, J.R. Croft, P.L. Arabia, and D.B. Marlowe. 2010. Corrected feedback: A procedure to enhance recall of informed consent to research among substance abusing offenders. Ethics and Behavior 20 (5): 387–399.Google Scholar
  45. 45.
    Widdershoven, G., G. Meynen, L. Hartman, and D. Denys. 2014. Ethical dilemmas in the practice of DBS. AJOB Neuroscience 5 (4): 83–85.Google Scholar
  46. 46.
    Bell, E., et al. 2011. A review of social and relational aspects of deep brain stimulation in Parkinson's disease informed by healthcare provider experiences. Parkinsons Disorder 2011: 871874.Google Scholar
  47. 47.
    Kubu, C.S., and P.J. Ford. 2012. Beyond mere symptom relief in deep brain stimulation: An ethical obligation for multi-faceted assessment of outcome. AJOB Neuroscience 3 (1): 44–49.Google Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Brain and Mental Health Research Hub, School of Psychological Sciences, Turner Institute for Brain and Mental HealthMonash UniversityMelbourneAustralia

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