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Scherrer S, Smith AH, Gowatsky J, Palmese CA, Jimenez-Shahed J, Kopell BH, Mayberg HS, Figee M. Impulsivity and Compulsivity After Subthalamic Deep Brain Stimulation for Parkinson's Disease. Front Behav Neurosci 2020; 14:47. [PMID: 32390809 PMCID: PMC7191054 DOI: 10.3389/fnbeh.2020.00047] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/17/2020] [Indexed: 01/04/2023] Open
Abstract
Impulsivity and compulsivity are prominent non-motor problems in Parkinson’s disease (PD). Despite 20 years of research, there is still an ongoing debate as to whether subthalamic deep brain stimulation (STN DBS) for PD exacerbates or improves these symptoms. Here, we review how STN DBS affects clinical symptoms and neurocognitive aspects of impulsivity and compulsivity. When comparing patients post- to pre-surgery, in the majority of studies STN DBS for PD is associated with a decrease in clinically diagnosed impulse-control disorders and disorders of compulsivity. To avoid confounds, such as post-surgical decreases in dopaminergic medication doses, comparisons can also be made between DBS “On” versus “Off” conditions. These experimentally assayed effects of STN DBS with respect to neurocognitive aspects of impulsivity and compulsivity are more mixed. STN DBS improves behavioral flexibility without impairing negative feedback learning, delay discounting, or inhibitory control, as long as stimulation is restricted to the dorsal STN. However, STN DBS may drive impulsive actions when a subject is faced with competing choices. We discuss how motivated responses may be either enhanced or impaired by STN DBS depending on engagement of dorsal or ventral STN-mediated circuits. Future studies should combine structural and functional circuit measures with behavioral testing in PD patients on and off medication and stimulation. A more sophisticated understanding of how to modulate cortico-striatal-thalamo-cortical loops will increase the likelihood that these circuit manipulation techniques can successfully be applied to a wider range of neuropsychiatric disorders.
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Affiliation(s)
- Sara Scherrer
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew H Smith
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jaimie Gowatsky
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Christina A Palmese
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joohi Jimenez-Shahed
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Brian H Kopell
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Helen S Mayberg
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Martijn Figee
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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52
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Baertschi M, Favez N, Flores Alves Dos Santos J, Radomska M, Herrmann F, Burkhard PR, Canuto A, Weber K, Ghisletta P. Illness Representations and Coping Strategies in Patients Treated with Deep Brain Stimulation for Parkinson's Disease. J Clin Med 2020; 9:E1186. [PMID: 32326245 PMCID: PMC7230846 DOI: 10.3390/jcm9041186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/26/2022] Open
Abstract
There is a debate on possible alterations of self-identity following deep brain stimulation for neurological disorders including Parkinson's disease. Among the psychological variables likely to undergo changes throughout such a medical procedure, illness representations and coping strategies have not been the target of much research to this day. In order to remedy this, we investigated the dynamics of illness representations and coping strategies in an 18-month longitudinal study involving 45 patients undergoing deep brain stimulation for idiopathic Parkinson's disease. Two research hypotheses were formulated and investigated through repeated measures of ANOVAs and structural equation modelling with full information maximum likelihood and Bayesian estimations. Representations of Parkinson's disease as a cyclical condition and perception of control over the disease diminished after surgery. Use of instrumental coping strategies was not modified after deep brain stimulation. These changes were identified by SEM but not ANOVAs; their magnitude was nevertheless relatively small, implying general stability in representations. These findings suggest that psychological variables do not undergo major changes after deep brain stimulation for Parkinson's disease.
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Affiliation(s)
- Marc Baertschi
- Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont-d’Arve 40, 1205 Geneva, Switzerland; (N.F.); (M.R.); (P.G.)
- Nant Foundation, Service of General Psychiatry and Psychotherapy, Avenue des Alpes 66, 1820 Montreux, Switzerland
| | - Nicolas Favez
- Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont-d’Arve 40, 1205 Geneva, Switzerland; (N.F.); (M.R.); (P.G.)
| | - João Flores Alves Dos Santos
- Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland;
| | - Michalina Radomska
- Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont-d’Arve 40, 1205 Geneva, Switzerland; (N.F.); (M.R.); (P.G.)
| | - François Herrmann
- Division of Geriatrics, Geneva University Hospitals, Chemin du Pont-Bochet 3, 1226 Thônex, Switzerland;
| | - Pierre R. Burkhard
- Service of Neurology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland;
| | - Alessandra Canuto
- Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1206 Geneva, Switzerland; (A.C.); (K.W.)
| | - Kerstin Weber
- Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1206 Geneva, Switzerland; (A.C.); (K.W.)
| | - Paolo Ghisletta
- Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont-d’Arve 40, 1205 Geneva, Switzerland; (N.F.); (M.R.); (P.G.)
- Swiss Distance Learning University, Überlandstrasse 12, 3900 Brig, Switzerland
- Swiss National Centre of Competence in Research LIVES—Overcoming Vulnerability: Life Course Perspectives, Universities of Lausanne and of Geneva, CH-1015 Lausanne, Switzerland
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53
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Neuropsychiatric aspects of Parkinson disease psychopharmacology: Insights from circuit dynamics. HANDBOOK OF CLINICAL NEUROLOGY 2020; 165:83-121. [PMID: 31727232 DOI: 10.1016/b978-0-444-64012-3.00007-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Parkinson disease (PD) is a neurodegenerative disorder with a complex pathophysiology characterized by the progressive loss of dopaminergic neurons within the substantia nigra. Persons with PD experience several motoric and neuropsychiatric symptoms. Neuropsychiatric features of PD include depression, anxiety, psychosis, impulse control disorders, and apathy. In this chapter, we will utilize the National Institutes of Mental Health Research Domain Criteria (RDoC) to frame and integrate observations from two prevailing disease constructions: neurotransmitter anomalies and circuit physiology. When there is available evidence, we posit how unified translational observations may have clinical relevance and postulate importance outside of PD. Finally, we review the limited evidence available for pharmacologic management of these symptoms.
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54
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Limousin P, Foltynie T. Long-term outcomes of deep brain stimulation in Parkinson disease. Nat Rev Neurol 2020; 15:234-242. [PMID: 30778210 DOI: 10.1038/s41582-019-0145-9] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The efficacy of deep brain stimulation (DBS) for Parkinson disease (PD) is well established for up to 1 or 2 years, but long-term outcome data are still limited. In this Review, we critically discuss the evidence on the long-term outcomes of DBS and consider the clinical implications. Although many patients are lost to follow-up, the evidence indicates that subthalamic nucleus DBS improves motor function for up to 10 years, although the magnitude of improvement tends to decline over time. Functional scores recorded during on-medication periods worsen more quickly than those recorded in off periods, consistent with the degeneration of non-dopaminergic pathways. Dyskinesia, motor fluctuations and activities of daily living in off periods remain improved at 5 years, but quality-of-life scores have usually fallen below preoperative levels. The incidence and severity of dementia among patients receiving DBS are comparable to those among patients who receive medical treatment. Severe adverse events are rare, but adverse events such as dysarthria are common and probably under-reported. Long-term data on the outcomes of globus pallidus interna DBS are limited and mostly confirm the efficacy for dyskinesia. A trend towards offering DBS in the earlier stages of PD creates a need to identify factors that predict long-term outcomes and to discuss realistic expectations with patients preoperatively.
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Affiliation(s)
- Patricia Limousin
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK. .,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Tom Foltynie
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK.,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Vachez Y, Carcenac C, Magnard R, Kerkerian‐Le Goff L, Salin P, Savasta M, Carnicella S, Boulet S. Subthalamic Nucleus Stimulation Impairs Motivation: Implication for Apathy in Parkinson's Disease. Mov Disord 2020; 35:616-628. [DOI: 10.1002/mds.27953] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Yvan Vachez
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | - Carole Carcenac
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | - Robin Magnard
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | | | | | - Marc Savasta
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | - Sebastien Carnicella
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | - Sabrina Boulet
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
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Poon CH, Chan YS, Fung ML, Lim LW. Memory and neuromodulation: A perspective of DNA methylation. Neurosci Biobehav Rev 2019; 111:57-68. [PMID: 31846654 DOI: 10.1016/j.neubiorev.2019.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/05/2019] [Accepted: 12/13/2019] [Indexed: 02/07/2023]
Abstract
Neuromodulation techniques have shown promising efficacy on memory function and understanding the epigenetic mechanisms contributing to these processes would shed light on the molecular outcomes essential for cognition. In this review, we highlight some epigenetic mechanisms underlying neuromodulation and regulatory effects of neuronal activity-induced DNA methylation on genes that are highly involved in memory formation. Next, we examine the evidence to support DNA methyltransferase 3a, methyl-CpG binding protein 2, and DNA demethylase as possible memory modulation targets. Finally, we report the recent developments in the field of neuromodulation and explore the potential of these techniques for future neuroepigenetic research.
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Affiliation(s)
- Chi Him Poon
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ying-Shing Chan
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Man Lung Fung
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lee Wei Lim
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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58
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Subjective estimates of uncertainty during gambling and impulsivity after subthalamic deep brain stimulation for Parkinson's disease. Sci Rep 2019; 9:14795. [PMID: 31616015 PMCID: PMC6794275 DOI: 10.1038/s41598-019-51164-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/25/2019] [Indexed: 01/08/2023] Open
Abstract
Subthalamic deep brain stimulation (DBS) for Parkinson’s disease (PD) may modulate chronometric and instrumental aspects of choice behaviour, including motor inhibition, decisional slowing, and value sensitivity. However, it is not well known whether subthalamic DBS affects more complex aspects of decision-making, such as the influence of subjective estimates of uncertainty on choices. In this study, 38 participants with PD played a virtual casino prior to subthalamic DBS (whilst ‘on’ medication) and again, 3-months postoperatively (whilst ‘on’ stimulation). At the group level, there was a small but statistically significant decrease in impulsivity postoperatively, as quantified by the Barratt Impulsiveness Scale (BIS). The gambling behaviour of participants (bet increases, slot machine switches and double or nothing gambles) was associated with this self-reported measure of impulsivity. However, there was a large variance in outcome amongst participants, and we were interested in whether individual differences in subjective estimates of uncertainty (specifically, volatility) were related to differences in pre- and postoperative impulsivity. To examine these individual differences, we fit a computational model (the Hierarchical Gaussian Filter, HGF), to choices made during slot machine game play as well as a simpler reinforcement learning model based on the Rescorla-Wagner formalism. The HGF was superior in accounting for the behaviour of our participants, suggesting that participants incorporated beliefs about environmental uncertainty when updating their beliefs about gambling outcome and translating these beliefs into action. A specific aspect of subjective uncertainty, the participant’s estimate of the tendency of the slot machine’s winning probability to change (volatility), increased subsequent to DBS. Additionally, the decision temperature of the response model decreased post-operatively, implying greater stochasticity in the belief-to-choice mapping of participants. Model parameter estimates were significantly associated with impulsivity; specifically, increased uncertainty was related to increased postoperative impulsivity. Moreover, changes in these parameter estimates were significantly associated with the maximum post-operative change in impulsivity over a six month follow up period. Our findings suggest that impulsivity in PD patients may be influenced by subjective estimates of uncertainty (environmental volatility) and implicate a role for the subthalamic nucleus in the modulation of outcome certainty. Furthermore, our work outlines a possible approach to characterising those persons who become more impulsive after subthalamic DBS, an intervention in which non-motor outcomes can be highly variable.
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59
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Krack P, Volkmann J, Tinkhauser G, Deuschl G. Deep Brain Stimulation in Movement Disorders: From Experimental Surgery to Evidence‐Based Therapy. Mov Disord 2019; 34:1795-1810. [DOI: 10.1002/mds.27860] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Paul Krack
- Department of Neurology Bern University Hospital and University of Bern Bern Switzerland
| | - Jens Volkmann
- Department of Neurology University Hospital and Julius‐Maximilian‐University Wuerzburg Germany
| | - Gerd Tinkhauser
- Department of Neurology Bern University Hospital and University of Bern Bern Switzerland
| | - Günther Deuschl
- Department of Neurology University Hospital Schleswig Holstein (UKSH), Kiel Campus; Christian‐Albrechts‐University Kiel Germany
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60
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Weintraub D, Mamikonyan E. The Neuropsychiatry of Parkinson Disease: A Perfect Storm. Am J Geriatr Psychiatry 2019; 27:998-1018. [PMID: 31006550 PMCID: PMC7015280 DOI: 10.1016/j.jagp.2019.03.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 12/16/2022]
Abstract
Affective disorders, cognitive decline, and psychosis have long been recognized as common in Parkinson disease (PD), and other psychiatric disorders include impulse control disorders, anxiety symptoms, disorders of sleep and wakefulness, and apathy. Psychiatric aspects of PD are associated with numerous adverse outcomes, yet in spite of this and their frequent occurrence, there is incomplete understanding of epidemiology, presentation, risk factors, neural substrate, and management strategies. Psychiatric features are typically multimorbid, and there is great intra- and interindividual variability in presentation. The hallmark neuropathophysiological changes that occur in PD, plus the association between exposure to dopaminergic medications and certain psychiatric disorders, suggest a neurobiological basis for many psychiatric symptoms, although psychological factors are involved as well. There is evidence that psychiatric disorders in PD are still under-recognized and undertreated and although psychotropic medication use is common, controlled studies demonstrating efficacy and tolerability are largely lacking. Future research on neuropsychiatric complications in PD should be oriented toward determining modifiable correlates or risk factors and establishing efficacious and well-tolerated treatment strategies.
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Affiliation(s)
- Daniel Weintraub
- Perelman School of Medicine (DW, EM), University of Pennsylvania, Philadelphia; Parkinson's Disease Research, Education and Clinical Center (PADRECC) (DW), Philadelphia Veterans Affairs Medical Center, Philadelphia.
| | - Eugenia Mamikonyan
- Perelman School of Medicine (DW, EM), University of Pennsylvania, Philadelphia
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61
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Chen KS, Chen R. Invasive and Noninvasive Brain Stimulation in Parkinson's Disease: Clinical Effects and Future Perspectives. Clin Pharmacol Ther 2019; 106:763-775. [DOI: 10.1002/cpt.1542] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/07/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Kai‐Hsiang Stanley Chen
- Krembil Research Institute University Health Network Toronto Ontario Canada
- Department of Neurology National Taiwan University Hospital Hsin‐Chu Branch Hsin‐Chu Taiwan
| | - Robert Chen
- Krembil Research Institute University Health Network Toronto Ontario Canada
- Division of Neurology Department of Medicine University of Toronto Toronto Ontario Canada
- Edmond J. Safra Program in Parkinson's Disease University Health Network Toronto Ontario Canada
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62
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Berardelli I, Belvisi D, Pasquini M, Fabbrini A, Petrini F, Fabbrini G. Treatment of psychiatric disturbances in hypokinetic movement disorders. Expert Rev Neurother 2019; 19:965-981. [PMID: 31241368 DOI: 10.1080/14737175.2019.1636648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: We reviewed studies that assessed the treatment of psychiatric disturbances in Parkinson's disease and atypical parkinsonisms. Neuropsychiatric disturbances in these conditions are frequent and have a profound impact on quality of life of patients and of their caregivers. It is therefore important to be familiar with the appropriate pharmacological and non-pharmacological interventions for treating these disorders. Areas covered: The authors searched for papers in English in Pubmed using the following keywords: Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, Lewy body dementia, depression, apathy, anxiety, fatigue, sleep disorders, obsessive compulsive disorders, psychosis, hallucinations, delusions, impulse control disorders. Expert opinion: In Parkinson's disease, depression may benefit from the optimization of dopaminergic therapy, from the use of antidepressants acting on both the serotoninergic and noradrenergic pathways and from cognitive behavioral therapy. Psychosis in Parkinson's disease may improve with the use of clozapine; the serotonin inverse agonist pimavanserin has been shown to be effective. Treatment of impulse control disorders is primarily based on the removal of dopamine agonists. No controlled studies have investigated the treatment of neuropsychiatric disorders in multiple system atrophy, progressive supranuclear palsy or corticobasal degeneration. Acethylcholinesterase inhibitors may be used to treat hallucinations in Lewy body dementia.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | | | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
| | - Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
| | - Federica Petrini
- Department of Neurosciences and Mental Health, Azienda Universitaria Policlinico Umberto I° , Rome , Italy
| | - Giovanni Fabbrini
- IRCCS Neuromed , Pozzilli , Italy.,Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
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63
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Shepard MD, Perepezko K, Broen MPG, Hinkle JT, Butala A, Mills KA, Nanavati J, Fischer NM, Nestadt P, Pontone G. Suicide in Parkinson's disease. J Neurol Neurosurg Psychiatry 2019; 90:822-829. [PMID: 30661029 PMCID: PMC7187903 DOI: 10.1136/jnnp-2018-319815] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/24/2018] [Accepted: 12/27/2018] [Indexed: 01/22/2023]
Abstract
Persons with Parkinson's disease (PwP) have many known risk factors for suicide and suicidal ideation (SI). Despite this, there is limited understanding of suicidality in this population. We conducted a systematic review to synthesise the available literature on suicidality in PwP and highlight areas for potential intervention and further research. We identified 116 articles discussing SI, suicidal behaviours, suicide attempts and/or fatal suicide in PwP. These articles describe prevalence, suicide methods, risk factors for suicide and SI and treatment of suicidality. In this review, we summarise the current literature and provide suggestions for how clinicians can identify and treat PwP who are at risk for suicide, for example, through aggressive treatment of depression and improved screening for access to lethal means.
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Affiliation(s)
- Melissa Deanna Shepard
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kate Perepezko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Martijn P G Broen
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jared Thomas Hinkle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ankur Butala
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly A Mills
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Morris K. Udall Parkinson's Disease Research Center of Excellence, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie Nanavati
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole Mercado Fischer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gregory Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Morris K. Udall Parkinson's Disease Research Center of Excellence, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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64
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Vitale C, Amboni M, Erro R, Picillo M, Pellecchia MT, Barone P, Trojano L, Santangelo G. Parkinson’s disease management and impulse control disorders: current state and future perspectives. Expert Rev Neurother 2019; 19:495-508. [DOI: 10.1080/14737175.2019.1620603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Carmine Vitale
- Department of Motor Sciences and Health, University “Parthenope”, Naples, Italy
| | - Marianna Amboni
- Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Roberto Erro
- Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Marina Picillo
- Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Maria Teresa Pellecchia
- Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Paolo Barone
- Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Luigi Trojano
- Department of Psychology, University “Luigi Vanvitelli”, Caserta, Italy
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Evans AH, Okai D, Weintraub D, Lim SY, O'Sullivan SS, Voon V, Krack P, Sampaio C, Post B, Leentjens AFG, Martinez-Martin P, Stebbins GT, Goetz CG, Schrag A. Scales to assess impulsive and compulsive behaviors in Parkinson's disease: Critique and recommendations. Mov Disord 2019; 34:791-798. [PMID: 31136681 DOI: 10.1002/mds.27689] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/11/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022] Open
Abstract
Impulse control disorders (ICDs) and related impulsive and compulsive behaviors (together called ICBs) have been increasingly recognized in the context of Parkinson's disease (PD) and treatment. The International Parkinson's and Movement Disorder Society commissioned a task force to assess available clinical screening instruments and rating scales, including their clinimetric properties, make recommendations regarding their utility, and suggest future directions in scale development and validation. The literature was systematically searched for scales measuring a range of reported ICBs in PD. A scale was designated "recommended" if the scale had been employed in PD studies, been used beyond the group that developed it, and had adequate clinimetric data published for PD. Numerous diagnostic screening tools and severity rating scales were identified for a range of ICBs, including compulsive medication use, punding/hobbyism, walkabout, pathological gambling, hypersexuality, compulsive or binge eating, compulsive buying, reckless driving, compulsive exercise, pyromania, trichotillomania, hoarding, kleptomania, intermittent explosive disorder, and internet addiction. For screening across the range of ICBs (except compulsive medication use), the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease (QUIP) and QUIP-Rating Scale (QUIP-RS) are recommended, and for severity rating across the range of ICBs the QUIP-RS and the Ardouin Scale of Behavior in Parkinson's Disease are recommended. The Scale for Outcomes in Parkinson's Disease-Psychiatric Complications is recommended for rating of hypersexuality and the compulsive behaviors gambling/shopping. Further testing of established scales against gold standard diagnostic criteria is urgently required for all other individual ICBs in PD. © 2019 International Parkinson and Movement Disorder Society © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Andrew H Evans
- Department of Neurology, the Royal Melbourne Hospital, Parkville, Australia
| | - David Okai
- Kings College London, Institute of Psychiatry, Section of Cognitive Neuropsychiatry, London, UK
| | - Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Parkinson's Disease and Mental Illness Research, Education and Clinical Centers (Philadelphia Parkinson's Disease Research, Education and Clinical Center (PADRECC) and Mental Illness Research Education Clinical, Centers of Excellence (MIRECC)), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sean S O'Sullivan
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Neurology, Bon Secours Hospital, Cork, Ireland
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paul Krack
- Movement Disorders Center, Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern Switzerland
| | - Cristina Sampaio
- Cure Huntington's Disease InitiativeEl (CHDI) Management/CHDI Foundation, Princeton, New Jersey, USA
| | - Bart Post
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pablo Martinez-Martin
- National Center of Epidemiology and Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Anette Schrag
- Department of Clinical Neurosciences, Institute of Neurology, University College London, London, UK
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Koeglsperger T, Palleis C, Hell F, Mehrkens JH, Bötzel K. Deep Brain Stimulation Programming for Movement Disorders: Current Concepts and Evidence-Based Strategies. Front Neurol 2019; 10:410. [PMID: 31231293 PMCID: PMC6558426 DOI: 10.3389/fneur.2019.00410] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/04/2019] [Indexed: 11/16/2022] Open
Abstract
Deep brain stimulation (DBS) has become the treatment of choice for advanced stages of Parkinson's disease, medically intractable essential tremor, and complicated segmental and generalized dystonia. In addition to accurate electrode placement in the target area, effective programming of DBS devices is considered the most important factor for the individual outcome after DBS. Programming of the implanted pulse generator (IPG) is the only modifiable factor once DBS leads have been implanted and it becomes even more relevant in cases in which the electrodes are located at the border of the intended target structure and when side effects become challenging. At present, adjusting stimulation parameters depends to a large extent on personal experience. Based on a comprehensive literature search, we here summarize previous studies that examined the significance of distinct stimulation strategies for ameliorating disease signs and symptoms. We assess the effect of adjusting the stimulus amplitude (A), frequency (f), and pulse width (pw) on clinical symptoms and examine more recent techniques for modulating neuronal elements by electrical stimulation, such as interleaving (Medtronic®) or directional current steering (Boston Scientific®, Abbott®). We thus provide an evidence-based strategy for achieving the best clinical effect with different disorders and avoiding adverse effects in DBS of the subthalamic nucleus (STN), the ventro-intermedius nucleus (VIM), and the globus pallidus internus (GPi).
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Affiliation(s)
- Thomas Koeglsperger
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Franz Hell
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Martinsried, Germany
| | - Jan H Mehrkens
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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Ruggiero F, Cortese F, Lavazza A, D’Urso G, Di Nuzzo C, Marceglia S, Pravettoni G, Priori A, Ferrucci R. Do Neurodegenerative Diseases Affect Creativity? Divergent Thinking in Frontotemporal Dementia and Parkinson’s Disease. CREATIVITY RESEARCH JOURNAL 2019. [DOI: 10.1080/10400419.2019.1577667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- F. Ruggiero
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
| | - F. Cortese
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
- Ospedale G. Fracastoro
- Università La Sapienza
| | - A. Lavazza
- Centro Universitario Internazionale Arezzo
| | | | - C. Di Nuzzo
- Centro ‘Aldo Ravelli’, Università degli Studi di Milano
| | - S. Marceglia
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
- Dipartimento di Ingegneria e Architettura, Università degli Studi di Trieste
| | - G Pravettoni
- Unità di Psiconcologia, Istituto Europeo di Oncologia
- Dipartimento di Oncologia DIPO, Università degli Studi di Miano
| | - A. Priori
- Centro ‘Aldo Ravelli’, Università degli Studi di Milano
- UOC Neurologia I, ASST Santi Paolo e Carlo
| | - R. Ferrucci
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
- Centro ‘Aldo Ravelli’, Università degli studi di Milano and UOC Neurologia I, ASST Santi Paolo e Carlo
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68
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Laurencin C, Thobois S. Malattia di Parkinson e depressione. Neurologia 2019. [DOI: 10.1016/s1634-7072(19)42021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mosley PE, Robinson K, Coyne T, Silburn P, Breakspear M, Carter A. ‘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-NETH 2019. [DOI: 10.1007/s12152-019-09410-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Biomarkers for closed-loop deep brain stimulation in Parkinson disease and beyond. Nat Rev Neurol 2019; 15:343-352. [DOI: 10.1038/s41582-019-0166-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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71
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Weintraub D. Impulse control disorders in Parkinson's disease: A 20‐year odyssey. Mov Disord 2019; 34:447-452. [DOI: 10.1002/mds.27668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 12/31/2022] Open
Affiliation(s)
- Daniel Weintraub
- Department of PsychiatryPerelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania USA
- Parkinson's Disease and Mental Illness ResearchEducation and Clinical Centers, Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USA
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Béreau M, Krack P, Brüggemann N, Münte TF. Neurobiology and clinical features of impulse control failure in Parkinson's disease. Neurol Res Pract 2019; 1:9. [PMID: 33324875 PMCID: PMC7650064 DOI: 10.1186/s42466-019-0013-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/12/2019] [Indexed: 12/02/2022] Open
Abstract
Impulse control disorders (ICDs) and other impulsive-compulsive related behaviours are frequent and still under recognized non-motor complications of Parkinson's disease (PD). They result from sensitization of the mesocorticolimbic pathway that arose in predisposed PD patients concomitantly with spreading of PD pathology, non-physiological dopaminergic and pulsatile administration of dopamine replacement therapy (DRT). Neuropsychiatric fluctuations (NPF) reflect the psychotropic effects of dopaminergic drugs and play a crucial role in the emergence of ICDs and behavioral addictions. Dopamine agonists (DA) which selectively target D2 and D3 receptors mostly expressed within the mesocorticolimbic pathway, are the main risk factor to develop ICDs. Neuroimaging studies suggest that dopamine agonists lead to a blunted response of the brain's reward system both during reward delivery and anticipation. Genetic predispositions are crucial for the responsiveness of the mesolimbic system and the development of ICDs with several genes having been identified. Early screening for neuropsychiatric fluctuations, reduction of DA, fractionating levodopa dosage, education of patients and their relatives, are the key strategies for diagnosis and management of ICDs and related disorders.
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Affiliation(s)
- Matthieu Béreau
- Department of Neurology, University Hospital of Besançon, 25030 Besançon, Cedex France
| | - Paul Krack
- Department of Neurology, Inselspital, University of Bern, CH-3010 Bern, Switzerland
| | | | - Thomas F. Münte
- Department of Neurology, University of Lübeck, 23562 Lübeck, Germany
- Institute of Psychology II, University of Lübeck, 23562 Lübeck, Germany
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73
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Current treatment of behavioral and cognitive symptoms of Parkinson's disease. Parkinsonism Relat Disord 2019; 59:65-73. [PMID: 30852149 DOI: 10.1016/j.parkreldis.2019.02.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 12/19/2022]
Abstract
Cognitive and behavioral symptoms are common in Parkinson's disease, may occur even in the prodromal stages of the disease, worsen with disease progression, and surpass motor symptoms as the major factors affecting patient quality of life and caregiver burden. The symptoms may be caused by the disease pathology or they may represent adverse effects of treatment, or both etiological factors may contribute. Although many of these symptoms are related to dopaminergic dysfunction or dopaminergic medication, other neurotransmitters are involved as well. Behavioral symptoms including impulse control disorders, apathy, psychosis, as well as mild cognitive impairment and dementia are reviewed with a special focus on current treatment approaches.
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Eisinger RS, Ramirez-Zamora A, Carbunaru S, Ptak B, Peng-Chen Z, Okun MS, Gunduz A. Medications, Deep Brain Stimulation, and Other Factors Influencing Impulse Control Disorders in Parkinson's Disease. Front Neurol 2019; 10:86. [PMID: 30863353 PMCID: PMC6399407 DOI: 10.3389/fneur.2019.00086] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
Impulse control disorders (ICDs) in Parkinson's disease (PD) have a high cumulative incidence and negatively impact quality of life. ICDs are influenced by a complex interaction of multiple factors. Although it is now well-recognized that dopaminergic treatments and especially dopamine agonists underpin many ICDs, medications alone are not the sole cause. Susceptibility to ICD is increased in the setting of PD. While causality can be challenging to ascertain, a wide range of modifiable and non-modifiable risk factors have been linked to ICDs. Common characteristics of PD patients with ICDs have been consistently identified across many studies; for example, males with an early age of PD onset and dopamine agonist use have a higher risk of ICD. However, not all cases of ICDs in PD can be directly attributable to dopamine, and studies have concluded that additional factors such as genetics, smoking, and/or depression may be more predictive. Beyond dopamine, other ICD associations have been described but remain difficult to explain, including deep brain stimulation surgery, especially in the setting of a reduction in dopaminergic medication use. In this review, we will summarize the demographic, genetic, behavioral, and clinical contributions potentially influencing ICD onset in PD. These associations may inspire future preventative or therapeutic strategies.
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Affiliation(s)
- Robert S. Eisinger
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Hospital Padre Hurtado, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Samuel Carbunaru
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Brandon Ptak
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Zhongxing Peng-Chen
- Hospital Padre Hurtado, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Michael S. Okun
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
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Lhommée E, Wojtecki L, Czernecki V, Witt K, Maier F, Tonder L, Timmermann L, Hälbig TD, Pineau F, Durif F, Witjas T, Pinsker M, Mehdorn M, Sixel-Döring F, Kupsch A, Krüger R, Elben S, Chabardès S, Thobois S, Brefel-Courbon C, Ory-Magne F, Regis JM, Maltête D, Sauvaget A, Rau J, Schnitzler A, Schüpbach M, Schade-Brittinger C, Deuschl G, Houeto JL, Krack P. Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson's disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial. Lancet Neurol 2019; 17:223-231. [PMID: 29452685 DOI: 10.1016/s1474-4422(18)30035-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving combined treatment with subthalamic stimulation and medical therapy over a 2-year follow-up period as compared with the behavioural evolution under medical therapy alone. METHODS We did a parallel, open-label study (EARLYSTIM) at 17 surgical centres in France (n=8) and Germany (n=9). We recruited patients with Parkinson's disease who were disabled by early motor complications. Participants were randomly allocated (1:1) to either medical therapy alone or bilateral subthalamic stimulation plus medical therapy. The primary outcome was mean change in quality of life from baseline to 2 years. A secondary analysis was also done to assess behavioural outcomes. We used the Ardouin Scale of Behavior in Parkinson's Disease to assess changes in behaviour between baseline and 2-year follow-up. Apathy was also measured using the Starkstein Apathy Scale, and depression was assessed with the Beck Depression Inventory. The secondary analysis was done in all patients recruited. We used a generalised estimating equations (GEE) regression model for individual items and mixed model regression for subscores of the Ardouin scale and the apathy and depression scales. This trial is registered with ClinicalTrials.gov, number NCT00354133. The primary analysis has been reported elsewhere; this report presents the secondary analysis only. FINDINGS Between July, 2006, and November, 2009, 251 participants were recruited, of whom 127 were allocated medical therapy alone and 124 were assigned bilateral subthalamic stimulation plus medical therapy. At 2-year follow-up, the levodopa-equivalent dose was reduced by 39% (-363·3 mg/day [SE 41·8]) in individuals allocated bilateral subthalamic stimulation plus medical therapy and was increased by 21% (245·8 mg/day [40·4]) in those assigned medical therapy alone (p<0·0001). Neuropsychiatric fluctuations decreased with bilateral subthalamic stimulation plus medical therapy during 2-year follow-up (mean change -0·65 points [SE 0·15]) and did not change with medical therapy alone (-0·02 points [0·15]); the between-group difference in change from baseline was significant (p=0·0028). At 2 years, the Ardouin scale subscore for hyperdopaminergic behavioural disorders had decreased with bilateral subthalamic stimulation plus medical therapy (mean change -1·26 points [SE 0·35]) and had increased with medical therapy alone (1·12 points [0·35]); the between-group difference was significant (p<0·0001). Mean change from baseline at 2 years in the Ardouin scale subscore for hypodopaminergic behavioural disorders, the Starkstein Apathy Scale score, and the Beck Depression Inventory score did not differ between treatment groups. Antidepressants were stopped in 12 patients assigned bilateral subthalamic stimulation plus medical therapy versus four patients allocated medical therapy alone. Neuroleptics were started in nine patients assigned medical therapy alone versus one patient allocated bilateral subthalamic stimulation plus medical therapy. During the 2-year follow-up, two individuals assigned bilateral subthalamic stimulation plus medical therapy and one patient allocated medical therapy alone died by suicide. INTERPRETATION In a large cohort with Parkinson's disease and early motor complications, better overall behavioural outcomes were noted with bilateral subthalamic stimulation plus medical therapy compared with medical therapy alone. The presence of hyperdopaminergic behaviours and neuropsychiatric fluctuations can be judged additional arguments in favour of subthalamic stimulation if surgery is considered for disabling motor complications. FUNDING German Federal Ministry of Education and Research, French Programme Hospitalier de Recherche Clinique National, and Medtronic.
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Affiliation(s)
- Eugénie Lhommée
- Movement Disorder Unit, Neurology Department, Centre Hospitalier Universitaire (CHU) Grenoble Alpes, University Grenoble Alpes, Grenoble Institut des Neurosciences (GIN), and Institut National de Santé et en Recherche Médicale (INSERM) U1216, Grenoble, France
| | - Lars Wojtecki
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Virginie Czernecki
- Sorbonne University, Pierre and Marie Curie University Paris 6, Paris, France; Brain and Spine Institute, Paris, France; Neurology Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC) 1422, Paris, France
| | - Karsten Witt
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Franziska Maier
- Department of Neurology, University of Cologne, Cologne, Germany
| | | | - Lars Timmermann
- Department of Neurology, University of Cologne, Cologne, Germany; Department of Neurology, Philipps University of Marburg, Marburg, Germany
| | - Thomas D Hälbig
- NeuroCure Clinical Research Center (NCRC), Charité University Medical Center, Charité (Campus Mitte), Berlin, Germany
| | - Fanny Pineau
- Sorbonne University, Pierre and Marie Curie University Paris 6, Paris, France; Brain and Spine Institute, Paris, France; Neurology Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC) 1422, Paris, France
| | - Franck Durif
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Tatiana Witjas
- Neurology, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Marcus Pinsker
- Department of Neurosurgery, University Hospital, Freiburg, Germany
| | - Maximilian Mehdorn
- Department of Neurosurgery, Universitätsklinikum Schlsewig-Holstein, Kiel, Germany
| | - Friederike Sixel-Döring
- Department of Neurology, Philipps University of Marburg, Marburg, Germany; Paracelsus-Elena-Klinik, Kassel, Germany
| | - Andreas Kupsch
- Department of Neurology and Stereotactic Neurosurgery, University of Magdeburg, and Neurology Moves, Medical Center Bismarck Karrée, Berlin, Germany
| | - Rejko Krüger
- Center of Neurology, and Hertie Institute for Clinical Brain Research, University Hospital, Tübingen, Germany; Luxembourg Centre for Systems Biology, University of Luxembourg, Luxembourg City, Luxembourg; Department of Neurology, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Saskia Elben
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephan Chabardès
- Department of Neurosurgery, Centre Hospitalier Universitaire (CHU) Grenoble Alpes, University Grenoble Alpes, Grenoble Institut des Neurosciences (GIN), and Institut National de Santé et en Recherche Médicale (INSERM) U1216, Grenoble, France
| | - Stéphane Thobois
- Movement Disorder Unit, Neurologie C, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Centre National de la Recherche Scientifique (CNRS), Institut des Sciences Cognitives, Centre de Neurosciences Cognitives, Bron, France; Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Christine Brefel-Courbon
- Neurology Department and Centre Expert Parkinson, University Hospital Toulouse, Toulouse France; INSERM Toulouse NeuroImaging Centre, Toulouse France
| | - Fabienne Ory-Magne
- Neurology Department and Centre Expert Parkinson, University Hospital Toulouse, Toulouse France; INSERM Toulouse NeuroImaging Centre, Toulouse France
| | - Jean-Marie Regis
- Department of Functional Neurosurgery, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - David Maltête
- Department of Neurology, Rouen University Hospital, INSERM U1073, Rouen Faculty of Medicine, Rouen, France
| | - Anne Sauvaget
- Addictology and Liaison-Psychiatry Department, CIC 0004, CHU de Nantes, Hôtel Dieu, Nantes, France
| | - Jörn Rau
- Coordinating Centre for Clinical Trials of the Philipps-University of Marburg, Marburg, Germany
| | - Alfons Schnitzler
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Schüpbach
- Neurology Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC) 1422, Paris, France; Department of Neurology, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | | | - Gunther Deuschl
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Jean-Luc Houeto
- Department of Neurology, CIC-INSERM 1402, CHU de Poitiers; Université de Poitiers, Poitiers, France
| | - Paul Krack
- Movement Disorder Unit, Neurology Department, Centre Hospitalier Universitaire (CHU) Grenoble Alpes, University Grenoble Alpes, Grenoble Institut des Neurosciences (GIN), and Institut National de Santé et en Recherche Médicale (INSERM) U1216, Grenoble, France; Department of Clinical Neurosciences (Neurology), Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Seppi K, Ray Chaudhuri K, Coelho M, Fox SH, Katzenschlager R, Perez Lloret S, Weintraub D, Sampaio C. Update on treatments for nonmotor symptoms of Parkinson's disease-an evidence-based medicine review. Mov Disord 2019; 34:180-198. [PMID: 30653247 PMCID: PMC6916382 DOI: 10.1002/mds.27602] [Citation(s) in RCA: 547] [Impact Index Per Article: 109.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/26/2018] [Accepted: 12/12/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To update evidence-based medicine recommendations for treating nonmotor symptoms in Parkinson's disease (PD). BACKGROUND The International Parkinson and Movement Disorder Society Evidence-Based Medicine Committee's recommendations for treatments of PD were first published in 2002, updated in 2011, and now updated again through December 31, 2016. METHODS Level I studies testing pharmacological, surgical, or nonpharmacological interventions for the treatment of nonmotor symptoms in PD were reviewed. Criteria for inclusion and quality scoring were as previously reported. The disorders covered were a range of neuropsychiatric symptoms, autonomic dysfunction, disorders of sleep and wakefulness, pain, fatigue, impaired olfaction, and ophthalmologic dysfunction. Clinical efficacy, implications for clinical practice, and safety conclusions are reported. RESULTS A total of 37 new studies qualified for review. There were no randomized controlled trials that met inclusion criteria for the treatment of anxiety disorders, rapid eye movement sleep behavior disorder, excessive sweating, impaired olfaction, or ophthalmologic dysfunction. We identified clinically useful or possibly useful interventions for the treatment of depression, apathy, impulse control and related disorders, dementia, psychosis, insomnia, daytime sleepiness, drooling, orthostatic hypotension, gastrointestinal dysfunction, urinary dysfunction, erectile dysfunction, fatigue, and pain. There were no clinically useful interventions identified to treat non-dementia-level cognitive impairment. CONCLUSIONS The evidence base for treating a range of nonmotor symptoms in PD has grown substantially in recent years. However, treatment options overall remain limited given the high prevalence and adverse impact of these disorders, so the development and testing of new treatments for nonmotor symptoms in PD remains a top priority. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience at King's College and Parkinson Foundation International Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom
| | - Miguel Coelho
- Serviço de Neurologia, Hospital Santa Maria Instituto de Medicina Molecular Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Susan H Fox
- Edmond J Safra Program in Parkinson Disease, Movement Disorder Clinic, Toronto Western Hospital, and the University of Toronto Department of Medicine, Toronto, Ontario, Canada
| | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Danube Hospital, Vienna, Austria
| | - Santiago Perez Lloret
- Institute of Cardiology Research, University of Buenos Aires, National Research Council, Buenos Aires, Argentina
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson's Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Cristina Sampaio
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
- Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
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Atkinson-Clement C, Cavazzini É, Zénon A, Witjas T, Fluchère F, Azulay JP, Baunez C, Eusebio A. Effects of subthalamic nucleus stimulation and levodopa on decision-making in Parkinson's disease. Mov Disord 2019; 34:377-385. [PMID: 30681186 DOI: 10.1002/mds.27625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/26/2018] [Accepted: 11/30/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is frequently associated with behavioral disorders, particularly within the spectrum of motivated behaviors such as apathy or impulsivity. Both pharmacological and neurosurgical treatments have an impact on these impairments. However, there still is controversy as to whether subthalamic nucleus deep brain stimulation (STN-DBS) can cause or reduce impulsive behaviors. OBJECTIVES We aimed to identify the influence of functional surgery on decision-making processes in PD. METHODS We studied 13 PD patients and 13 healthy controls. The experimental task involved squeezing a dynamometer with variable force to obtain rewards of various values under four conditions: without treatment, with l-dopa or subthalamic stimulation alone, and with both l-dopa and subthalamic stimulation. Statistical analyses consisted of generalized linear mixed models including treatment condition, reward value, level of effort, and their interactions. We analyzed acceptance rate (the percentage of accepted trials), decision time, and force applied. RESULTS Comparatively to controls, patients without treatment exhibited lower acceptance rate and force applied. Patients under l-dopa alone did not exhibit increased acceptance rate. With subthalamic stimulation, either with or without added l-dopa, all measures were improved so that patients' behaviors were undistinguishable from healthy controls'. CONCLUSIONS Our study shows that l-dopa administration does not fully restore cost-benefit decision-making processes, whereas STN-DBS fully normalizes patients' behaviors. These findings suggest that dopamine is partly involved in cost-benefit valuation, and that STN-DBS can have a beneficial effect on motivated behaviors in PD and may improve certain forms of impulsive behaviors. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cyril Atkinson-Clement
- Aix Marseille Université, CNRS, LPL, Aix-en-Provence, France.,Aix Marseille Université, CNRS, INT, Inst Neurosci Timone, Marseille, France
| | | | - Alexandre Zénon
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.,INCIA, Université de Bordeaux, CNRS UMR5287, Bordeaux, France
| | - Tatiana Witjas
- Aix Marseille Université, CNRS, INT, Inst Neurosci Timone, Marseille, France.,Aix Marseille Université, APHM, CHU Timone, Department of Neurology and Movement Disorders, Marseille, France
| | - Frédérique Fluchère
- Aix Marseille Université, APHM, CHU Timone, Department of Neurology and Movement Disorders, Marseille, France.,Aix Marseille Université, CNRS, LNC, Marseille, France
| | - Jean-Philippe Azulay
- Aix Marseille Université, CNRS, INT, Inst Neurosci Timone, Marseille, France.,Aix Marseille Université, APHM, CHU Timone, Department of Neurology and Movement Disorders, Marseille, France
| | - Christelle Baunez
- Aix Marseille Université, CNRS, INT, Inst Neurosci Timone, Marseille, France
| | - Alexandre Eusebio
- Aix Marseille Université, CNRS, INT, Inst Neurosci Timone, Marseille, France.,Aix Marseille Université, APHM, CHU Timone, Department of Neurology and Movement Disorders, Marseille, France
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78
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A 7-year observation of the effect of subthalamic deep brain stimulation on impulse control disorder in patients with Parkinson's disease. Parkinsonism Relat Disord 2018; 56:3-8. [DOI: 10.1016/j.parkreldis.2018.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/12/2018] [Accepted: 07/19/2018] [Indexed: 11/18/2022]
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79
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Béreau M, Fleury V, Bouthour W, Castrioto A, Lhommée E, Krack P. Hyperdopaminergic behavioral spectrum in Parkinson's disease: A review. Rev Neurol (Paris) 2018; 174:653-663. [DOI: 10.1016/j.neurol.2018.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 02/08/2023]
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80
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Abbes M, Lhommée E, Thobois S, Klinger H, Schmitt E, Bichon A, Castrioto A, Xie J, Fraix V, Kistner A, Pélissier P, Seigneuret É, Chabardès S, Mertens P, Broussolle E, Moro E, Krack P. Subthalamic stimulation and neuropsychiatric symptoms in Parkinson's disease: results from a long-term follow-up cohort study. J Neurol Neurosurg Psychiatry 2018; 89:836-843. [PMID: 29436490 DOI: 10.1136/jnnp-2017-316373] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Reports on behavioural outcomes after subthalamic nucleus deep brain stimulation in Parkinson's disease are controversial and limited to short-term data. Long-term observation in a large cohort allows a better counselling and management. METHODS To determine whether a long-term treatment with subthalamic stimulation induces or reduces impulse control behaviours, neuropsychiatric fluctuations and apathy, 69 patients treated with subthalamic stimulation are prospectively and retrospectively assessed using Ardouin Scale of Behavior in Parkinson's Disease before and after 3-10 years of stimulation. RESULTS At a mean follow-up of 6 years, all impulse control disorders and dopaminergic addiction were significantly decreased, apart from eating behaviour and hypersexuality. Neuropsychiatric fluctuations also significantly improved (ON euphoria: 38% of the patients before surgery and 1% after surgery, P<0.01; OFF dysphoria: 39% of the patients before surgery and 10% after surgery, P<0.01). However, apathy increased (25% of the patients after surgery and 3% before, P<0.01). With the retrospective analysis, several transient episodes of depression, apathy, anxiety and impulse control disorders occurred. CONCLUSIONS Bilateral subthalamic nucleus stimulation was overall very effective in improving impulse control disorders and neuropsychiatric fluctuations in parkinsonian patients in the long term despite a counteracting frequent apathy. Transient episodes of impulse control disorders still occurred within the follow-up. These findings recommend a close follow-up in parkinsonian patients presenting with neuropsychiatric symptoms before deep brain stimulation surgery. CLINICAL TRIAL REGISTRATION NCT01705418;Post-results.
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Affiliation(s)
- Marie Abbes
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France
| | - Eugénie Lhommée
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Stéphane Thobois
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Université de Lyon, Lyon, France.,Neurologie C, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,Centre de Neurosciences Cognitives, CNRS, UMR 5229, Bron, France
| | - Hélène Klinger
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Université de Lyon, Lyon, France.,Neurologie C, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,Centre de Neurosciences Cognitives, CNRS, UMR 5229, Bron, France
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Amélie Bichon
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Anna Castrioto
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Jing Xie
- Institut du vieillissement, Hospices Civils de Lyon, Hôpital des Charpennes, Lyon, France
| | - Valérie Fraix
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Andrea Kistner
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Pierre Pélissier
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Éric Seigneuret
- Department of Neurosurgery, CHU Grenoble Alpes, Grenoble, France
| | - Stéphan Chabardès
- Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France.,Department of Neurosurgery, CHU Grenoble Alpes, Grenoble, France
| | - Patrick Mertens
- Neurochirurgie A, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France
| | - Emmanuel Broussolle
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Université de Lyon, Lyon, France.,Neurologie C, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,Centre de Neurosciences Cognitives, CNRS, UMR 5229, Bron, France
| | - Elena Moro
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Paul Krack
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France.,Department of Clinical Neuroscience, Faculty University of Geneva, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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81
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Huang Y, Aronson JP, Pilitsis JG, Gee L, Durphy J, Molho ES, Ramirez-Zamora A. Anatomical Correlates of Uncontrollable Laughter With Unilateral Subthalamic Deep Brain Stimulation in Parkinson's Disease. Front Neurol 2018; 9:341. [PMID: 29887826 PMCID: PMC5980955 DOI: 10.3389/fneur.2018.00341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 04/30/2018] [Indexed: 01/11/2023] Open
Abstract
Introduction Subthalamic nucleus deep brain stimulation (STN-DBS) is a well-established treatment for the management of motor complications in Parkinson’s disease. Uncontrollable laughter has been reported as a rare side effect of STN stimulation. The precise mechanism responsible for this unique phenomenon remains unclear. We examined in detail the DBS electrode position and stimulation parameters in two patients with uncontrollable laughter during programming after STN-DBS surgery and illustrated the anatomical correlates of the acute mood changes with STN stimulation. Case report Unilateral STN-DBS induced uncontrollable laughter with activation of the most ventral contacts in both patients. However, the location of the electrodes responsible for this adverse effect differed between the patients. In the first patient, the DBS lead was placed more inferiorly and medially within the STN. In the second patient, the DBS lead was implanted more anteriorly and inferiorly than initially planned at the level of the substantia nigra reticulata (SNr). Conclusion Unilateral STN-DBS can induce acute uncontrollable laughter with activation of electrodes located more anterior, medial, and inferior in relationship with the standard stereotactic STN target. We suggest that simulation of ventral and medial STN, surrounding limbic structures or the SNr, is the most plausible anatomical substrate responsible for this acute mood and behavioral change. Our findings provide insight into the complex functional neuroanatomical relationship of the STN and adjacent structures important for mood and behavior. DBS programming with more dorsal and lateral contacts within the STN should be entertained to minimize the emotional side effects.
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Affiliation(s)
- Yonglu Huang
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.,Department of Neurology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Joshua P Aronson
- Department of Surgery, Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
| | - Lucy Gee
- Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
| | - Jennifer Durphy
- Department of Neurology, Albany Medical Center, Albany, NY, United States
| | - Eric Steven Molho
- Department of Neurology, Albany Medical Center, Albany, NY, United States
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
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82
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Foley JA, Foltynie T, Limousin P, Cipolotti L. Standardised Neuropsychological Assessment for the Selection of Patients Undergoing DBS for Parkinson's Disease. PARKINSON'S DISEASE 2018; 2018:4328371. [PMID: 29971141 PMCID: PMC6009029 DOI: 10.1155/2018/4328371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/23/2018] [Accepted: 04/30/2018] [Indexed: 11/17/2022]
Abstract
DBS is an increasingly offered advanced treatment for Parkinson's disease (PD). Neuropsychological assessment is considered to be an important part of the screening for selection of candidates for this treatment. However, no standardised screening procedure currently exists. In this study, we examined the use of our standardised neuropsychological assessment for the evaluation of surgical candidates and to identify risk factors for subsequent decline in cognition and mood. A total of 40 patients were assessed before and after DBS. Evaluation of mood and case notes review was also undertaken. Before DBS, patients with PD demonstrated frequent impairments in intellectual functioning, memory, attention, and executive function, as well as high rates of mood disorder. Post-DBS, there was a general decline in verbal fluency only, and in one patient, we documented an immediate and irreversible global cognitive decline, which was associated with older age and more encompassing cognitive deficits at baseline. Case note review revealed that a high proportion of patients developed mood disorder, which was associated with higher levels of depression at baseline and greater reduction in levodopa medication. We conclude that our neuropsychological assessment is suitable for the screening of candidates and can identify baseline risk factors, which requires careful consideration before and after surgery.
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Affiliation(s)
- Jennifer A. Foley
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Tom Foltynie
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Patricia Limousin
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Lisa Cipolotti
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo, Palermo, Italy
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83
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Apathy following Bilateral Deep Brain Stimulation of Subthalamic Nucleus in Parkinson's Disease: A Meta-Analysis. PARKINSONS DISEASE 2018; 2018:9756468. [PMID: 29951186 PMCID: PMC5987292 DOI: 10.1155/2018/9756468] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/10/2018] [Accepted: 04/30/2018] [Indexed: 01/04/2023]
Abstract
Bilateral deep brain stimulation of subthalamic nucleus (STN-DBS) has proven effective in improving motor symptoms in Parkinson's disease (PD) patients. However, psychiatric changes after surgery are controversial. In this study, we specifically analyzed apathy following bilateral STN-DBS in PD patients using a meta-analysis. Relevant articles utilized for this study were obtained through literature search on PubMed, ScienceDirect, and Embase databases. The articles included were those contained both pre- and postsurgery apathy data acquired using the Starkstein Apathy Scale or Apathy Evaluation Scale with patient follow-up of at least three months. A total of 9 out of 86 articles were included in our study through this strict screening process. Standardized mean difference (SMD), that is, Cohen's d, with a 95% confidence interval (CI) was calculated to show the change. We found a significant difference between the presurgery stage and the postsurgery stage scores (SMD = 0.35, 95% CI: 0.17∼0.52, P < 0.001). STN-DBS seems to relatively worsen the condition of apathy, which may result from both the surgery target (subthalamic nucleus) and the reduction of dopaminergic medication. Further studies should focus on the exact mechanisms of possible postoperative apathy in the future.
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84
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Rossi M, Bruno V, Arena J, Cammarota Á, Merello M. Challenges in PD Patient Management After DBS: A Pragmatic Review. Mov Disord Clin Pract 2018; 5:246-254. [PMID: 30363375 PMCID: PMC6174419 DOI: 10.1002/mdc3.12592] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 01/01/2018] [Accepted: 01/15/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or internal globus pallidus (GPi) represents an effective and universally applied therapy for Parkinson's disease (PD) motor complications. However, certain procedure-related problems and unrealistic patient expectations may detract specialists from indicating DBS more widely despite significant clinical effects. METHODS This review provides a pragmatic educational summary of the most conflicting postoperative management issues in patients undergoing DBS for PD. RESULTS DBS in PD has been associated with certain complications and post-procedural management issues, which can complicate surgical outcome interpretation. Many PD patients consider DBS outcomes negative due to unfulfilled expectations, even when significant motor symptom improvement is achieved. Speech, gait, postural stability, and cognition may worsen after DBS and body weight may increase. Although DBS may induce impulse control disorders in some cases, in others, it may actually improve them when dopamine agonist dosage is reduced after surgery. However, apathy may also arise, especially when dopaminergic medication tapering is rapid. Gradual loss of response with time suggests disease progression, rather than the wearing off of DBS effects. Furthermore, implantable pulse generator expiration is considered a movement disorder emergency, as it may worsen parkinsonian symptoms or cause life-threatening akinetic crises due to malignant DBS withdrawal syndrome. CONCLUSION Major unsolved issues occurring after DBS therapy preclude complete patient satisfaction. Multidisciplinary management at experienced centers, as well as careful and comprehensive delivery of information to patients, should contribute to make DBS outcome expectations more realistic and allow post procedural complications to be better accepted.
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Affiliation(s)
- Malco Rossi
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Verónica Bruno
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
- Argentine National Scientific and Technological Research Council (CONICET)Buenos AiresArgentina
| | - Julieta Arena
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Ángel Cammarota
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Marcelo Merello
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
- Argentine National Scientific and Technological Research Council (CONICET)Buenos AiresArgentina
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85
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Pan Y, Wang L, Zhang Y, Zhang C, Qiu X, Tan Y, Zhou H, Sun B, Li D. Deep Brain Stimulation of the Internal Globus Pallidus Improves Response Initiation and Proactive Inhibition in Patients With Parkinson's Disease. Front Psychol 2018; 9:351. [PMID: 29681869 PMCID: PMC5897903 DOI: 10.3389/fpsyg.2018.00351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/02/2018] [Indexed: 01/10/2023] Open
Abstract
Background: Impulse control disorder is not uncommon in patients with Parkinson’s disease (PD) who are treated with dopamine replacement therapy and subthalamic deep brain stimulation (DBS). Internal globus pallidus (GPi)-DBS is increasingly used, but its role in inhibitory control has rarely been explored. In this study, we evaluated the effect of GPi-DBS on inhibitory control in PD patients. Methods: A stop-signal paradigm was used to test response initiation, proactive inhibition, and reactive inhibition. The subjects enrolled in the experiment were 27 patients with PD, of whom 13 had received only drug treatment and 14 had received bilateral GPi-DBS in addition to conventional medical treatment and 15 healthy individuals. Results: Our results revealed that with GPi-DBS on, patients with PD showed significantly faster responses than the other groups in trials where it was certain that no stop signal would be presented. Proactive inhibition was significantly different in the surgical patients with GPi-DBS on versus when GPi-DBS was off, in surgical patients with GPi-DBS on versus drug-treated patients, and in healthy controls versus drug-treated patients. Correlation analyses revealed that when GPi-DBS was on, there was a statistically significant moderate positive relationship between proactive inhibition and dopaminergic medication. Conclusion: GPi-DBS may lead to an increase in response initiation speed and improve the dysfunctional proactive inhibitory control observed in PD patients. Our results may help us to understand the role of the GPi in cortical-basal ganglia circuits.
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Affiliation(s)
- Yixin Pan
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linbin Wang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xian Qiu
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyan Tan
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Zhou
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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86
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Dissociable Effects of Subthalamic Stimulation in Obsessive Compulsive Disorder on Risky Reward and Loss Prospects. Neuroscience 2018; 382:105-114. [PMID: 29559386 DOI: 10.1016/j.neuroscience.2018.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 03/06/2018] [Accepted: 03/09/2018] [Indexed: 12/16/2022]
Abstract
Our daily decisions involve an element of risk, a behavioral process that is potentially modifiable. Here we assess the role of the associative-limbic subthalamic nucleus (STN) in obsessive compulsive disorder (OCD) testing on and off deep-brain stimulation (DBS) on anticipatory risk taking to obtain rewards and avoid losses. We assessed 12 OCD STN DBS in a randomized double-blind within-subject cross-over design. STN DBS decreased risk taking to rewards (p = 0.02) and greater risk taking to rewards was positively correlated with OCD severity (p = 0.01) and disease duration (p = 0.01). STN DBS was also associated with impaired subjective discrimination of loss magnitude (p < 0.05), an effect mediated by acute DBS rather than chronic DBS. We highlight a role for the STN in mediating dissociable valence prospects on risk seeking. STN stimulation decreases risk taking to rewards and impairs discrimination of loss magnitude. These findings may have implications for behavioral symptoms related to STN DBS and the potential for STN DBS for the treatment of psychiatric disorders.
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87
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Bétry C, Thobois S, Laville M, Disse E. Deep brain stimulation as a therapeutic option for obesity: A critical review. Obes Res Clin Pract 2018; 12:260-269. [PMID: 29475604 DOI: 10.1016/j.orcp.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/29/2018] [Accepted: 02/06/2018] [Indexed: 12/19/2022]
Abstract
Despite a better understanding of obesity pathophysiology, treating this disease remains a challenge. New therapeutic options are needed. Targeting the brain is a promising way, considering both the brain abnormalities in obesity and the effects of bariatric surgery on the gut-brain axis. Deep brain stimulation could be an alternative treatment for obesity since this safe and reversible neurosurgical procedure modulates neural circuits for therapeutic purposes. We aimed to provide a critical review of published clinical and preclinical studies in this field. Owing to the physiology of eating and brain alterations in people with obesity, two brain areas, namely the hypothalamus and the nucleus accumbens are putative targets. Preclinical studies with animal models of obesity showed that deep brain stimulation of hypothalamus or nucleus accumbens induces weight loss. The mechanisms of action remain to be fully elucidated. Preclinical data suggest that stimulation of nucleus accumbens reduces food intake, while stimulation of hypothalamus could increase resting energy expenditure. Clinical experience with deep brain stimulation for obesity remains limited to six patients with mixed results, but some clinical trials are ongoing. Thus, drawing clear conclusions about the effectiveness of this treatment is not yet possible, even if the results of preclinical studies are encouraging. Future clinical studies should examine its efficacy and safety, while preclinical studies could help understand its mechanisms of action. We hope that our review will provide ways to design further studies.
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Affiliation(s)
- Cécile Bétry
- Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; The Medical School, University of Nottingham, Nottingham, UK.
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hopital Neurologique Pierre Wertheimer, Service de neurologie C, Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud Charles Merieux, Lyon, France; CNRS, Institut des Sciences Cognitives Marc Jeannerot, UMR 5229, Bron, France
| | - Martine Laville
- Service d'Endocrinologie-Diabétologie-Maladies de la nutrition, Centre Intégré de l'Obésité, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Unité INSERM 1060, Laboratoire CARMEN, CENS-Centre Européen pour la Nutrition et la Santé, Centre de Recherche en Nutrition Humaine Rhône-Alpes., Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - Emmanuel Disse
- Service d'Endocrinologie-Diabétologie-Maladies de la nutrition, Centre Intégré de l'Obésité, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Unité INSERM 1060, Laboratoire CARMEN, CENS-Centre Européen pour la Nutrition et la Santé, Centre de Recherche en Nutrition Humaine Rhône-Alpes., Université Claude Bernard Lyon 1, Pierre Bénite, France
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88
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Chagraoui A, Boukhzar L, Thibaut F, Anouar Y, Maltête D. The pathophysiological mechanisms of motivational deficits in Parkinson's disease. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:138-152. [PMID: 29097256 DOI: 10.1016/j.pnpbp.2017.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/21/2017] [Accepted: 10/30/2017] [Indexed: 12/23/2022]
Abstract
Parkinson's disease (PD) is a progressive degenerative disorder that leads to disabling motor symptoms and a wide variety of neuropsychiatric symptoms. Apathy is the most common psychiatric disorder in the early stages of untreated PD and can be defined as a hypodopaminergic syndrome, which also includes anxiety and depression. Apathy is also considered the core feature of the parkinsonian triad (apathy, anxiety and depression) of behavioural non-motor signs, including a motivational deficit. Moreover, apathy is recognised as a distinct chronic neuropsychiatric behavioural disorder based on specific diagnostic criteria. Given the prevalence of apathy in approximately 40% of the general Parkinson's disease population, this appears to be a contributing factor to dementia in PD; also, apathy symptoms are factors that potentially contribute to morbidity, leading to a major impairment of health-related quality of life, thus stressing the importance of understanding the pathophysiology of this disease. Several studies have clearly established a prominent role for DA-mediated signals in PD apathy. However, synergistic interaction between dopaminergic impairment resulting from the neurodegenerative process and deep brain stimulation of the subthalamic nucleus may cause or exacerbate apathy. Furthermore, serotoninergic mechanism signalling is also likely to be of importance in this pathophysiology.
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Affiliation(s)
- A Chagraoui
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France.; Department of Medical Biochemistry, Rouen University Hospital, Rouen, France.
| | - L Boukhzar
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France
| | - F Thibaut
- Department of Psychiatry, University Hospital Cochin (site Tarnier), University of Paris-Descartes and INSERM U 894 Laboratory of Psychiatry and Neurosciences, Paris, France
| | - Y Anouar
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France
| | - D Maltête
- Department of Neurology, Rouen University Hospital, Rouen, France
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Neuropsychological performance changes following subthalamic versus pallidal deep brain stimulation in Parkinson's disease: a systematic review and metaanalysis. CNS Spectr 2018; 23:10-23. [PMID: 28236811 DOI: 10.1017/s1092852917000062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies comparing subthalamus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) for the management of Parkinson's disease in terms of neuropsychological performance are scarce and heterogeneous. Therefore, we performed a systematic review and metaanalysis to compare neuropsychological outcomes following STN DBS versus GPi DBS. METHODS A computer literature search of PubMed, the Web of Science, and Cochrane Central was conducted. Records were screened for eligible studies, and data were extracted and synthesized using Review Manager (v. 5.3 for Windows). RESULTS Seven studies were included in the qualitative synthesis. Of them, four randomized controlled trials (n=345 patients) were pooled in the metaanalysis models. The standardized mean difference (SMD) of change in the Stroop color-naming test favored the GPi DBS group (SMD=-0.31, p=0.009). However, other neuropsychological outcomes did not favor either of the two groups (Stroop word-reading: SMD=-0.21, p=0.08; the Wechsler Adult Intelligence Scale (WAIS) digits forward: SMD=0.08, p=0.47; Trail Making Test Part A: SMD=-0.05, p=0.65; WAIS-R digit symbol: SMD=-0.16, p=0.29; Trail Making Test Part B: SMD=-0.14, p=0.23; Stroop color-word interference: SMD=-0.16, p=0.18; phonemic verbal fluency: bilateral DBS SMD=-0.04, p=0.73, and unilateral DBS SMD=-0.05, p=0.83; semantic verbal fluency: bilateral DBS SMD=-0.09, p=0.37, and unilateral DBS SMD=-0.29, p=0.22; Boston Naming Test: SMD=-0.11, p=0.33; Beck Depression Inventory: bilateral DBS SMD=0.15, p=0.31, and unilateral DBS SMD=0.36, p=0.11). CONCLUSIONS There was no statistically significant difference in most of the neuropsychological outcomes. The present evidence does not favor any of the targets in terms of neuropsychological performance.
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Bargiotas P, Eugster L, Oberholzer M, Debove I, Lachenmayer ML, Mathis J, Pollo C, Schüpbach WMM, Bassetti CL. Sleep-wake functions and quality of life in patients with subthalamic deep brain stimulation for Parkinson's disease. PLoS One 2017; 12:e0190027. [PMID: 29253029 PMCID: PMC5734707 DOI: 10.1371/journal.pone.0190027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Sleep-wake disturbances (SWD) are frequent in Parkinson's disease (PD). The effect of deep brain stimulation (DBS) on SWD is poorly known. In this study we examined the subjective and objective sleep-wake profile and the quality of life (QoL) of PD patients in the context of subthalamic DBS. PATIENTS AND METHODS We retrospectively analyzed data from PD patients and candidates for DBS in the nucleus suthalamicus (STN). Pre-DBS, sleep-wake assessments included subjective and objective (polysomnography, vigilance tests and actigraphy) measures. Post-DBS, subjective measures were collected. QoL was assessed using the Parkinson's Disease Questionnaire (PDQ-39) and the RAND SF-36-item Health Survey (RAND SF-36). RESULTS Data from 74 PD patients (62% male, mean age 62.2 years, SD = 8.9) with a mean UPDRS-III (OFF) of 34.2 (SD = 14.8) and 11.8 (SD = 4.5) years under PD treatment were analyzed. Pre-DBS, daytime sleepiness, apathy, fatigue and depressive symptoms were present in 49%, 34%, 38% and 25% of patients respectively but not always as co-occurring symptoms. Sleep-wake disturbances were significantly correlated with QoL scores. One year after STN DBS, motor signs, QoL and sleepiness improved but apathy worsened. Changes in QoL were associated with changes in sleepiness and apathy but baseline sleep-wake functions were not predictive of STN DBS outcome. CONCLUSION In PD patients presenting for STN DBS, subjective and objective sleep-wake disturbances are common and have a negative impact on QoL before and after neurosurgery. Given the current preliminary evidence, prospective observational studies assessing subjective and objective sleep-wake variables prior to and after DBS are needed.
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Affiliation(s)
- Panagiotis Bargiotas
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- * E-mail:
| | - Lukas Eugster
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Michael Oberholzer
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Ines Debove
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - M. Lenard Lachenmayer
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Johannes Mathis
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - W. M. Michael Schüpbach
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Claudio L. Bassetti
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
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91
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Warren N, O'Gorman C, Lehn A, Siskind D. Dopamine dysregulation syndrome in Parkinson's disease: a systematic review of published cases. J Neurol Neurosurg Psychiatry 2017; 88:1060-1064. [PMID: 29018160 DOI: 10.1136/jnnp-2017-315985] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/13/2017] [Accepted: 08/01/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Dopamine dysregulation syndrome (DDS) is an uncommon complication of the treatment of Parkinson's disease, characterised by addictive behaviour and excessive use of dopaminergic medication. DDS may frequently go unrecognised or misdiagnosed. We aimed to clarify current understanding of presentation, risk factors, comorbidities and management of DDS. METHODS Case reports were identified through a systematic search of databases (PubMed, Embase) with the following terms: dopaminergic dysregulation syndrome, hedonistic homeostatic dysregulation, dopamine/levodopa addiction. RESULTS We reviewed 390 articles, identifying 98 cases of DDS. Early-onset Parkinson's disease (67%) and male gender (83%) were common. DDS presented with significant physical and social impairment, actions to enable or prevent detection of overuse, as well as mood, anxiety and motor fluctuations. All DDS cases met DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) substance use disorder criteria. Past substance and psychiatric history was present in 15.3% and 10.2% of cases. Comorbid impulse control disorders (61%), psychosis (32%) and panic attacks (14%) were common. A large variety of management strategies were used; only 56% of cases resolving. Sodium valproate was successful in 5/5 cases. The response to deep brain stimulation varied. CONCLUSIONS Given the functional impairment, medical and psychiatric consequences and the difficulties of treatment, early identification of DDS should be a priority.
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Affiliation(s)
- Nicola Warren
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Psychiatry, Metro South Addiction and Mental Health Services, Brisbane, Queensland, Australia
| | - Cullen O'Gorman
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Dan Siskind
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Psychiatry, Metro South Addiction and Mental Health Services, Brisbane, Queensland, Australia
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92
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Mehanna R, Bajwa JA, Fernandez H, Wagle Shukla AA. Cognitive Impact of Deep Brain Stimulation on Parkinson's Disease Patients. PARKINSON'S DISEASE 2017; 2017:3085140. [PMID: 29359065 PMCID: PMC5735627 DOI: 10.1155/2017/3085140] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/15/2017] [Accepted: 10/16/2017] [Indexed: 11/17/2022]
Abstract
Subthalamic nucleus (STN) or globus pallidus interna (GPi) deep brain stimulation (DBS) is considered a robust therapeutic tool in the treatment of Parkinson's disease (PD) patients, although it has been reported to potentially cause cognitive decline in some cases. We here provide an in-depth and critical review of the current literature regarding cognition after DBS in PD, summarizing the available data on the impact of STN and GPi DBS as monotherapies and also comparative data across these two therapies on 7 cognitive domains. We provide evidence that, in appropriately screened PD patients, worsening of one or more cognitive functions is rare and subtle after DBS, without negative impact on quality of life, and that there is very little data supporting that STN DBS has a worse cognitive outcome than GPi DBS.
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Affiliation(s)
- Raja Mehanna
- University of Texas Health Science Center, Houston, TX, USA
| | - Jawad A. Bajwa
- Parkinson's, Movement Disorders and Neurorestoration Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hubert Fernandez
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
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93
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Obeso I, Casabona E, Rodríguez-Rojas R, Bringas ML, Macías R, Pavón N, Obeso JA, Jahanshahi M. Unilateral subthalamotomy in Parkinson's disease: Cognitive, psychiatric and neuroimaging changes. Cortex 2017; 94:39-48. [DOI: 10.1016/j.cortex.2017.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/18/2017] [Accepted: 06/08/2017] [Indexed: 12/28/2022]
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Rossi PJ, De Jesus S, Hess CW, Martinez-Ramirez D, Foote KD, Gunduz A, Okun MS. Measures of impulsivity in Parkinson's disease decrease after DBS in the setting of stable dopamine therapy. Parkinsonism Relat Disord 2017; 44:13-17. [PMID: 28827010 DOI: 10.1016/j.parkreldis.2017.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/26/2017] [Accepted: 08/07/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Recent evidence suggests deep brain stimulation can alter impulse control. Our objective was to prospectively evaluate the effects of subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation on impulse control disorders (ICDs) in the setting of a conservative dopamine reduction strategy. METHODS Patients (n = 37) undergoing de novo, unilateral STN or GPi DBS lead implantation were evaluated pre-operatively and 6-12 months post-operatively for the presence of ICDs using the Questionnaire for Impulsivity in Parkinson's disease (QUIP) and by clinical interview. RESULTS Of the patients enrolled, 23 underwent electrode implantation in the globus pallidus internus and 14 were implanted in the subthalamic nucleus. Mean time to long term follow-up was 9.7 ± 2.4 months. Post-operative LEDD was not significantly lower than pre-operative LEDD (pre-op: 1238.53 ± 128.47 vs. post-op: 1178.18 ± 126.43, p = 0.2972, paired t-test). Mean QUIP scores were significantly lower at follow up compared to pre-operative baseline (1.51 ± 0.45 vs. 2.51 ± 0.58, p = 0.0447, paired t-test). Patients with ICDs pre-operatively (n = 14, 37.8%) had significant improvement in QUIP scores at follow-up (6.00 ± 0.94 vs. 2.64 ± 0.98, p = 0.0014, paired t-test). Improvement was not uniform across the cohort: 1 patient with ICD at baseline developed worsening symptoms, and 4 patients with no ICD pre-operatively developed clinically significant ICDs post-operatively. CONCLUSION When LEDD is relatively unchanged following STN or GPi DBS for PD, ICD symptoms tend toward improvement, although worsening and emergence of new ICDs can occur. In the setting of stable LEDD, these findings suggest that the intrinsic effects of DBS may play a significant role in altering impulsive behavior.
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Affiliation(s)
- P Justin Rossi
- Center for Movement Disorders and Neurorestoration, University of Florida, 3450 Hull Road, Gainesville, FL 32607, USA.
| | - Sol De Jesus
- Center for Movement Disorders and Neurorestoration, University of Florida, 3450 Hull Road, Gainesville, FL 32607, USA
| | - Christopher W Hess
- Center for Movement Disorders and Neurorestoration, University of Florida, 3450 Hull Road, Gainesville, FL 32607, USA
| | - Daniel Martinez-Ramirez
- Center for Movement Disorders and Neurorestoration, University of Florida, 3450 Hull Road, Gainesville, FL 32607, USA
| | - Kelly D Foote
- Center for Movement Disorders and Neurorestoration, University of Florida, 3450 Hull Road, Gainesville, FL 32607, USA
| | - Aysegul Gunduz
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL 32610, USA
| | - Michael S Okun
- Center for Movement Disorders and Neurorestoration, University of Florida, 3450 Hull Road, Gainesville, FL 32607, USA
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Abstract
Deep brain stimulation (DBS) is effective for Parkinson's disease (PD), dystonia, and essential tremor (ET). While motor benefits are well documented, cognitive and psychiatric side effects from the subthalamic nucleus (STN) and globus pallidus interna (GPi) DBS for PD are increasingly recognized. Underlying disease, medications, microlesions, and post-surgical stimulation likely all contribute to non-motor symptoms (NMS).
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96
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Delpont B, Lhommée E, Klinger H, Schmitt E, Bichon A, Fraix V, Castrioto A, Quesada JL, Pélissier P, Kistner A, Carnicella S, Lüscher C, Broussolle E, Pollak P, Thobois S, Krack P. Psychostimulant effect of dopaminergic treatment and addictions in Parkinson's disease. Mov Disord 2017; 32:1566-1573. [DOI: 10.1002/mds.27101] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 05/23/2017] [Accepted: 06/04/2017] [Indexed: 01/13/2023] Open
Affiliation(s)
- Benoit Delpont
- Movement Disorders Unit; Neurology Department, CHU Grenoble Alpes and Université Grenoble Alpes; Grenoble France
| | - Eugénie Lhommée
- Movement Disorders Unit; Neurology Department, CHU Grenoble Alpes and Université Grenoble Alpes; Grenoble France
- Grenoble Institut des Neurosciences, Inserm, U1216; Grenoble France
| | - Hélène Klinger
- Service de Neurologie C, Université Lyon I, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer; Lyon France
- CNRS, UMR 5229, Centre de Neurosciences Cognitives; Lyon France
| | - Emmanuelle Schmitt
- Movement Disorders Unit; Neurology Department, CHU Grenoble Alpes and Université Grenoble Alpes; Grenoble France
- Grenoble Institut des Neurosciences, Inserm, U1216; Grenoble France
| | - Amélie Bichon
- Movement Disorders Unit; Neurology Department, CHU Grenoble Alpes and Université Grenoble Alpes; Grenoble France
- Grenoble Institut des Neurosciences, Inserm, U1216; Grenoble France
| | - Valérie Fraix
- Movement Disorders Unit; Neurology Department, CHU Grenoble Alpes and Université Grenoble Alpes; Grenoble France
- Grenoble Institut des Neurosciences, Inserm, U1216; Grenoble France
| | - Anna Castrioto
- Movement Disorders Unit; Neurology Department, CHU Grenoble Alpes and Université Grenoble Alpes; Grenoble France
- Grenoble Institut des Neurosciences, Inserm, U1216; Grenoble France
| | - Jean-Louis Quesada
- Unité Scientifique de la DRCI et Centre d'Investigation Clinique, CHU de Grenoble; Grenoble France
| | - Pierre Pélissier
- Movement Disorders Unit; Neurology Department, CHU Grenoble Alpes and Université Grenoble Alpes; Grenoble France
| | - Andrea Kistner
- Movement Disorders Unit; Neurology Department, CHU Grenoble Alpes and Université Grenoble Alpes; Grenoble France
| | | | - Christian Lüscher
- Department of Basic Neurosciences; Medical Faculty, University of Geneva, Geneva, Switzerland; Clinic of Neurology, Department of Clinical Neurosciences, Geneva University Hospital; Geneva Switzerland
| | - Emmanuel Broussolle
- Service de Neurologie C, Université Lyon I, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer; Lyon France
- CNRS, UMR 5229, Centre de Neurosciences Cognitives; Lyon France
| | - Pierre Pollak
- Department of Basic Neurosciences; Medical Faculty, University of Geneva, Geneva, Switzerland; Clinic of Neurology, Department of Clinical Neurosciences, Geneva University Hospital; Geneva Switzerland
| | - Stéphane Thobois
- Service de Neurologie C, Université Lyon I, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer; Lyon France
- CNRS, UMR 5229, Centre de Neurosciences Cognitives; Lyon France
| | - Paul Krack
- Movement Disorders Unit; Neurology Department, CHU Grenoble Alpes and Université Grenoble Alpes; Grenoble France
- Grenoble Institut des Neurosciences, Inserm, U1216; Grenoble France
- Department of Basic Neurosciences; Medical Faculty, University of Geneva, Geneva, Switzerland; Clinic of Neurology, Department of Clinical Neurosciences, Geneva University Hospital; Geneva Switzerland
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97
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Pelloux Y, Baunez C. Targeting the subthalamic nucleus in a preclinical model of alcohol use disorder. Psychopharmacology (Berl) 2017; 234:2127-2137. [PMID: 28401284 DOI: 10.1007/s00213-017-4618-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 03/27/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND The subthalamic nucleus (STN) has only recently been considered to have a role in reward processing. In rats, inactivation of the STN by lesion or high-frequency stimulation (HFS) decreases motivation for cocaine but increases motivation for sucrose. For ethanol, the effect of STN lesion depends on the individual's baseline intake; decreasing motivation for ethanol in rats with lower ethanol intake, while increasing motivation for ethanol in rats with higher-but still limited-ethanol intake. However, the involvement of the STN in behaviour more closely resembling some aspects of alcohol use disorder has not been assessed. This study aimed to determine the effect of STN lesions on the escalation of ethanol intake, subsequent increases in the motivation to "work" for ethanol and the choice of ethanol over a non-drug alternative. RESULTS We found that STN lesion prevented increases in ethanol intake observed during intermittent ethanol access and after a long period of ethanol privation. STN lesion also decreased the motivation to work for ethanol after escalated intake. Surprisingly, STN lesion increased the choice of alcohol over saccharin. This was associated with a blunting of the hedonic responses to the taste of the reinforcement alternatives. CONCLUSION These results evidence the involvement of the STN in different ethanol-motivated behaviours and therefore position the STN as an interesting target for the treatment of alcohol use disorders.
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Affiliation(s)
- Yann Pelloux
- Institut de Neurosciences de la Timone, UMR7289, CNRS & Aix-Marseille Université, 27, Boulevard Jean Moulin, 13005, Marseille, France.
- National Institute on Drug Abuse Intramural Research Program, 51 Bayview Blvd #200, Baltimore, MD, 21224, USA.
| | - Christelle Baunez
- Institut de Neurosciences de la Timone, UMR7289, CNRS & Aix-Marseille Université, 27, Boulevard Jean Moulin, 13005, Marseille, France
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98
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Lhommée E, Boyer F, Wack M, Pélissier P, Klinger H, Schmitt E, Bichon A, Fraix V, Chabardès S, Mertens P, Castrioto A, Kistner A, Broussolle E, Thobois S, Krack P. Personality, dopamine, and Parkinson's disease: Insights from subthalamic stimulation. Mov Disord 2017. [PMID: 28643887 DOI: 10.1002/mds.27065] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Subthalamic stimulation improves the motor and neuropsychiatric symptoms of Parkinson's disease. However, the impact of this treatment on impulse control and personality is the subject of heavy debate. The objective of this study was to investigate personality changes after subthalamic stimulation. METHODS Using Cloninger's biosocial model, we assessed personality in 73 Parkinson's disease patients before and 12 months after subthalamic stimulation accompanied by a drastic reduction in dopaminergic medication. Changes in psychobehavioral symptoms were measured using a battery of validated clinical scales (apathy, depression, anxiety, hyperemotionality, mania, psychosis, punding, and impulse control behaviors). RESULTS One year after surgery, the harm avoidance personality domain total score increased compared with the baseline (+2.8; 34 patients; P < 0.001), as did 3 of its 4 subdomains: anticipatory worry (+0.7; 10 patients; P = 0.005), shyness (+0.6; 7 patients; P = 0.03), and fatigability (+1.1; 10 patients; P = 0.0014). Evolution of the shyness personality trait correlated with the decrease in dopaminergic medication. Total scores in the other personality domains remained unchanged, except for extravagance, a subdomain of novelty seeking, and persistence, a subdomain of reward dependence, which both decreased following surgery (-0.3; 7 patients; and -0.6; 9 patients; P = 0.03 and P = 0.0019, respectively). Although apathy increased, other psychobehavioral symptoms, including impulse control behaviors and neuropsychiatric nonmotor fluctuations, improved. Depression and anhedonia remained stable. Scores in hypodopaminergia and neuropsychiatric nonmotor OFF correlated with harm avoidance. Scores in hyperdopaminergia and neuropsychiatric nonmotor ON correlated with novelty seeking. CONCLUSIONS When subthalamic stimulation is applied in Parkinson's disease, significant changes in personality traits are observed, which may be related to postoperative tapering of dopaminergic treatment. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Eugénie Lhommée
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - François Boyer
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France
| | - Maxime Wack
- Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France.,Service d'épidémiologie et évaluation cliniques, CHU de Nancy, Vandœuvre-lès-Nancy, France
| | - Pierre Pélissier
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France.,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France.,CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Amélie Bichon
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Valérie Fraix
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Stéphan Chabardès
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France.,Department of neurosurgery, CHU Grenoble Alpes, Grenoble, France
| | - Patrick Mertens
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France.,Hospices Civils de Lyon, Hôpital Neurologique, Neurochirurgie A, Lyon, France
| | - Anna Castrioto
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Andrea Kistner
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Emmanuel Broussolle
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France.,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France.,CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France.,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France.,CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Paul Krack
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France.,Present address: Department of Clinical Neuroscience, Hôpitaux Universitaires de Genève, Faculty University of Geneva, Switzerland
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99
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Weintraub D, Claassen DO. Impulse Control and Related Disorders in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:679-717. [PMID: 28802938 DOI: 10.1016/bs.irn.2017.04.006] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Impulse control disorders (ICDs), such as compulsive gambling, buying, sexual, and eating behaviors, are a serious and increasingly recognized complication in Parkinson's disease (PD), occurring in up to 20% of PD patients over the course of their illness. Related behaviors include punding (stereotyped, repetitive, purposeless behaviors), dopamine dysregulation syndrome (DDS) (compulsive medication overuse), and hobbyism (e.g., compulsive internet use, artistic endeavors, and writing). These disorders have a significant impact on quality of life and function, strain interpersonal relationships, and worsen caregiver burden, and are associated with significant psychiatric comorbidity. ICDs have been most closely related to the use of dopamine agonists (DAs), while DDS is primarily associated with shorter acting, higher potency dopamine replacement therapy (DRT), such as levodopa. However, in preliminary research ICDs have also been reported to occur with monoamine oxidase inhibitor-B and amantadine treatment, and after deep brain stimulation (DBS) surgery. Other risk factors for ICDs may include sex (e.g., male sex for compulsive sexual behavior, and female sex for compulsive buying behavior); younger age overall at PD onset; a pre-PD history of an ICD; personal or family history of substance abuse, bipolar disorder, or gambling problems; and impulsive personality traits. Dysregulation of the mesocorticolimbic dopamine system is thought to be the major neurobiological substrate for ICDs in PD, but there is preliminary evidence for alterations in opiate and serotonin systems too. The primary treatment of ICDs in PD is discontinuation of the offending treatment, but not all patients can tolerate this due to worsening motor symptoms or DA withdrawal syndrome. While psychiatric medications and psychosocial treatments are frequently used to treat ICDs in the general population, there is limited empirical evidence for their use in PD, so it is critical for patients to be monitored closely for ICDs from disease onset and routine throughout its course. In the future, it may be possible to use a precision medicine approach to decrease the incidence of ICDs in PD by avoiding DA use in patients determined to be at highest risk based on their clinical and neurobiological (e.g., motor presentation, behavioral measures of medication response, genetics, dopamine transporter neuroimaging) profile. Additionally, as empirically validated treatments for ICDs and similar disorders (e.g., substance use disorders) emerge, it will also be important to examine their efficacy and tolerability in individuals with comorbid PD.
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Affiliation(s)
- Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Parkinson's Disease and Mental Illness Research, Education and Clinical Centers, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States.
| | - Daniel O Claassen
- Vanderbilt University School of Medicine, Nashville, TN, United States
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Shahmoon S, Jahanshahi M. Optimizing psychosocial adjustment after deep brain stimulation of the subthalamic nucleus in Parkinson's disease. Mov Disord 2017; 32:1155-1158. [PMID: 28504352 DOI: 10.1002/mds.27032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Suzette Shahmoon
- Cognitive Motor Neuroscience Group & Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
| | - Marjan Jahanshahi
- Cognitive Motor Neuroscience Group & Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
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