The Burden of Normality as a Model of Psychosocial Adjustment After Deep Brain Stimulation for Parkinson's Disease: A Systematic Investigation

Objective: Deep brain stimulation (DBS) has become a well-established treatment that significantly improves the motor symptoms of Parkinson's disease (PD). Patients may nevertheless experience psychosocial maladjustment after surgery, as reported by an increasing body of research. Yet, no comprehensive theoretical approach has been proposed to account for this. Initially conceptualized for postsurgical epilepsy, the burden of normality (BoN) may be viewed as a model that is potentially applicable to psychosocial maladjustment after PD-DBS. Method: We systematically examined the literature to verify this assumption by scrutinizing the 3 theoretical levels of the BoN, specifically, precursory conditions for the applicability of the model, clinical manifestations of psychosocial maladjustment, and 2 mediating variables: expectations and discarding the roles associated with the pretreatment condition. Results: The applicability of the BoN to PD-DBS found support for the first 2 of these 3 levels in 88 scientific articles included in the review. The number of studies that addressed the mediating variables was nevertheless insufficient to draw any definitive conclusion. The degenerative condition of PD further limits the distinction between symptoms pertaining to psychosocial maladjustment and disease progression. Conclusions: Considering psychosocial maladjustment through the lens of the BoN is complementary to the traditional medical perspective of PD-DBS and illuminates the potential contribution of specialists from multiple disciplines in clinical rehabilitation. Deep brain stimulation efficiently alleviates motor symptoms of Parkinson's disease. Nonetheless, some patients experience intra- and interpersonal difficulties after surgery. Through a review of the literature, we examine whether the burden of normality, a theoretical model of psychosocial adjustment, could illuminate this issue. We conclude that psychosocial adjustment plays a pivotal role in rehabilitation and advocate the implementation of multidisciplinary programs.