Long-term effects of STN DBS on mood: Psychosocial profiles remain stable in a 3-year follow-up

Department of Neurosurgery, Medical University of Vienna, Austria.
BMC Neurology (Impact Factor: 2.04). 12/2008; 8(1):43. DOI: 10.1186/1471-2377-8-43
Source: PubMed


Deep brain stimulation of the subthalamic nucleus significantly improves motor function in patients with severe Parkinson's disease. However, the effects on nonmotor aspects remain uncertain. The present study investigated the effects of subthalamic nucleus deep brain stimulation on mood and psychosocial functions in 33 patients with advanced Parkinson's disease in a three year follow-up.
Self-rating questionnaires were administered to 33 patients prior to surgery as well as three, six, twelve and 36 months after surgery.
In the long run, motor function significantly improved after surgery. Mood and psychosocial functions transiently improved at one year but returned to baseline at 36 months after surgery. In addition, we performed cluster and discriminant function analyses and revealed four distinct psychosocial profiles, which remained relatively stable in the course of time. Two profiles featured impaired psychosocial functioning while the other two of them were characterized by greater psychosocial stability.
Compared to baseline no worsening in mood and psychosocial functions was found three years after electrode implantation. Moreover, patients can be assigned to four distinct psychosocial profiles that are relatively stable in the time course. Since these subtypes already exist preoperatively the extent of psychosocial support can be anticipatory adjusted to the patients' needs in order to enhance coping strategies and compliance. This would allow early detection and even prevention of potential psychiatric adverse events after surgery. Given adequate psychosocial support, these findings imply that patients with mild psychiatric disturbances should not be excluded from surgery.

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    • "In a structured review of 23 cohort and case studies found that depression reduced or remained unchanged after STN DBS within the first year of surgery, whereas little effect on depression level was observed after any of the other procedures [i.e., Ref. (23)]. A separate study assessed 33 patients, after undergoing STN DBS, finding that symptoms of depression decreased significantly (p = 0.007) post-surgery up until the first year and then returning to pre-surgery level at year 3 (43). In contrast, Castelli and colleagues (44) found that depression at the 3-year follow-up visit did not improve in the STN DBS group compared to an l-DOPA control group who did not undergo DBS surgery. "
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    ABSTRACT: Although ~50% of patients with Parkinson’s disease (PD) experience depression, treatment for this important and debilitating comorbidity is relatively understudied. Deep brain stimulation (DBS) has been increasingly utilized for the management of tremors in progressive PD. Several preliminary studies have shown the potential benefit of DBS for non-motor PD symptoms such as depression. Here, we critically evaluate seven recent randomized clinical trials of the effectiveness of DBS in reducing depressive symptomatology among individuals with PD. Findings are mixed for the effectiveness of DBS as a treatment for depression in PD. Our review suggests that this is due, in large part, to the anatomical and methodological variation across the DBS studies. We provide a comprehensive discussion of these variations and highlight the need to conduct larger, more controlled studies aimed specifically at evaluating the treatment of depression in PD patients.
    Frontiers in Neurology 08/2014; 5(154). DOI:10.3389/fneur.2014.00154
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    • "In the literature, it was reported that STN DBS cannot stop the natural progression of PD11,36). Kaiser et al.15) reviewed 38 PD patients who underwent STN DBS and mentioned that their psychosocial profiles transiently improved at 12 months after surgery but returned to baseline at 36 months. Tsai et al.33) reported that neuropsychological effects after STN DBS were closely related to anterior location of the active electrode contact within the ventral STN. "
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    ABSTRACT: Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective treatment of choice for patients with advanced idiopathic Parkinson's disease (PD) who have motor complication with medication. The objectives of this study are to analyze long-term follow-up data of STN DBS cases and to identify the factors related to outcomes. Fifty-two PD patients who underwent STN DBS were followed-up for more than 3 years. The Unified Parkinsons Disease Rating Scale (UPDRS) and other clinical profiles were assessed preoperatively and during follow-up. A linear regression model was used to analyze whether factors predict the results of STN DBS. We divided the study individuals into subgroups according to several factors and compared subgroups. Preoperative activity of daily living (ADL) and the magnitude of preoperative levodopa response were shown to predict the improvement in UPDRS part II without medication, and preoperative ADL and levodopa equivalent dose (LED) were shown to predict the improvement in UPDRS part II with medication. In UPDRS part III with medication, the magnitude of preoperative levodopa response was a predicting factor. The intensity of preoperative levodopa response was a strong factor for motor outcome. And preoperative ADL and LED were strong factors for ADL improvement. More vigorous studies should be conducted to elucidate how levodopa-induced motor complications are ameliorated after STN DBS.
    Journal of Korean Neurosurgical Society 08/2013; 54(2):118-24. DOI:10.3340/jkns.2013.54.2.118 · 0.64 Impact Factor
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    ABSTRACT: The efficacy of deep brain stimulation (DBS) for the motor symptoms of advanced Parkinson's disease (PD) is well established. However, the effects of DBS on nonmotor symptoms (NMS) are less clear. To review the published literature on nonmotor aspects of DBS for PD. The outcome of NMS after DBS in PD varies across studies. Some symptoms improve -sleep disorders, pain or sensory complaints, obsessive-compulsive disorder- and other aspects decline or appear -word fluency, apathy, body weight gain-. Isolated studies note mild improvements in working memory, visuomotor sequencing and conceptual reasoning, some gastrointestinal, urogenital, sweating and olfactory disturbances; whereas other studies have reported declines in verbal memory (long delay recall), visuospatial memory, processing speed and executive function; orthostatic hypotension remains without changes. The reasons for such a range of symptoms observed is due to the multifactorial etiology of the NMS, including preoperative vulnerability, changes in dopaminergic medications, surgical and stimulation effects, underlying PD-related factors and psychosocial effects. Specific patient subgroups may be at greater risk of cognitive deficits -e.g., those older than 69 years or with cognitive impairment prior to surgery- or depression, mania and suicide -e.g., those ones with preoperative psychiatric symptoms-. Patients who undergo DBS must be well-selected, weighing the risks and benefits, in order to obtain the best results with this treatment. Further multicentre studies are necessary to understand the role of DBS on NMS.
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