Predicting Acute Affective Symptoms after Deep Brain Stimulation Surgery in Parkinson’s Disease

Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany. fschneider @
Stereotactic and Functional Neurosurgery (Impact Factor: 2.02). 09/2010; 88(6):367-73. DOI: 10.1159/000319046
Source: PubMed


The current study aimed to investigate predictive markers for acute symptoms of depression and mania following deep brain stimulation (DBS) surgery of the subthalamic nucleus for the treatment of motor symptoms in Parkinson's disease (PD). Fourteen patients with PD (7 males) were included in a prospective longitudinal study. Neuropsychological tests, psychopathology scales and tests of motor functions were administered at several time points prior to and after neurosurgery. Pre-existing psychopathological and motor symptoms predicted postoperative affective side effects of DBS surgery. As these can easily be assessed, they should be considered along with other selection criteria for DBS surgery.

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    Stereotactic and Functional Neurosurgery 07/2011; 89(4):258-9. DOI:10.1159/000328884 · 2.02 Impact Factor
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    ABSTRACT: Parkinson's disease is a neurodegenerative disorder attributable to midbrain dopaminergic cell loss within the substantia nigra. This causes a dysfunction of the basal ganglia manifested by motor symptoms such as tremor, rigidity, bradykinesia among others. With Deep Brain Stimulation (DBS), neurosurgery has emerged as a therapeutic option, being the subthalamic nucleus its main target area. Studies show significant improvement in motor deficits, but there is no knowledge on the neuropsychological changes in patients after DBS. A review of several studies that have researched the cognitive, emotional and behavioral changes concluded that most cognitive skills are either maintained or improved after DBS, but there may be adverse emotional and behavioral changes that are related to the core brain where the electrode is implanted and with its premorbid personality characteristics.
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    ABSTRACT: Deep brain stimulation of the subthalamic nucleus (DBS) is a widely used surgical technique to suppress motor symptoms in Parkinson's disease (PD), and as such improves patients' quality of life. However, DBS may produce emotional disorders such as a reduced ability to recognize emotional facial expressions (EFE). Previous studies have not considered the fact that DBS and l-dopa medication can have differential, common, or complementary consequences on EFE processing. A thorough way of investigating the effect of DBS and l-dopa medication in greater detail is to compare patients' performances after surgery, with the two therapies either being administered ('on') or not administered ('off'). We therefore used a four-condition (l-dopa 'on'/DBS 'on', l-dopa 'on'/DBS 'off', l-dopa 'off'/DBS 'on', and l-dopa 'off'/DBS 'off') EFE recognition paradigm and compared implanted PD patients to healthy controls. The results confirmed those of previous studies, yielding a significant impairment in the detection of some facial expressions relative to controls. Disgust recognition was impaired when patients were 'off' l-dopa and 'on' DBS, and fear recognition impaired when 'off' of both therapies. More interestingly, the combined effect of both DBS and l-dopa administration seems much more beneficial for EFE recognition than the separate administration of each individual therapy. We discuss the implications of these findings in the light of the inverted U curve function that describes the differential effects of dopamine level on the right orbitofrontal cortex (OFC). We propose that, while l-dopa could "overdose" in dopamine the ventral stream of the OFC, DBS would compensate for this over-activation by decreasing OFC activity, thereby restoring the necessary OFC-amygdala interaction. Another finding is that, when collapsing over all treatment conditions, PD patients recognized more neutral faces than the matched controls, a result that concurs with embodiment theories.
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