101
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Huang CS, Wang GH, Tai CH, Hu CC, Yang YC. Antiarrhythmics cure brain arrhythmia: The imperativeness of subthalamic ERG K + channels in parkinsonian discharges. SCIENCE ADVANCES 2017; 3:e1602272. [PMID: 28508055 PMCID: PMC5425237 DOI: 10.1126/sciadv.1602272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
ERG K+ channels have long been known to play a crucial role in shaping cardiac action potentials and, thus, appropriate heart rhythms. The functional role of ERG channels in the central nervous system, however, remains elusive. We demonstrated that ERG channels exist in subthalamic neurons and have similar gating characteristics to those in the heart. ERG channels contribute crucially not only to the setting of membrane potential and, consequently, the firing modes, but also to the configuration of burst discharges and, consequently, the firing frequency and automaticity of the subthalamic neurons. Moreover, modulation of subthalamic discharges via ERG channels effectively modulates locomotor behaviors. ERG channel inhibitors ameliorate parkinsonian symptoms, whereas enhancers render normal animals hypokinetic. Thus, ERG K+ channels could be vital to the regulation of both cardiac and neuronal rhythms and may constitute an important pathophysiological basis and pharmacotherapeutic target for the growing list of neurological disorders related to "brain arrhythmias."
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Affiliation(s)
- Chen-Syuan Huang
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Guan-Hsun Wang
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chun-Hwei Tai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Chang Hu
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ya-Chin Yang
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
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102
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Spagnolo PA, Goldman D. Neuromodulation interventions for addictive disorders: challenges, promise, and roadmap for future research. Brain 2017; 140:1183-1203. [PMID: 28082299 PMCID: PMC6059187 DOI: 10.1093/brain/aww284] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/24/2016] [Accepted: 09/12/2016] [Indexed: 01/27/2023] Open
Abstract
Addictive disorders are a major public health concern, associated with high relapse rates, significant disability and substantial mortality. Unfortunately, current interventions are only modestly effective. Preclinical studies as well as human neuroimaging studies have provided strong evidence that the observable behaviours that characterize the addiction phenotype, such as compulsive drug consumption, impaired self-control, and behavioural inflexibility, reflect underlying dysregulation and malfunction in specific neural circuits. These developments have been accompanied by advances in neuromodulation interventions, both invasive as deep brain stimulation, and non-invasive such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation. These interventions appear particularly promising as they may not only allow us to probe affected brain circuits in addictive disorders, but also seem to have unique therapeutic applications to directly target and remodel impaired circuits. However, the available literature is still relatively small and sparse, and the long-term safety and efficacy of these interventions need to be confirmed. Here we review the literature on the use of neuromodulation in addictive disorders to highlight progress limitations with the aim to suggest future directions for this field.
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Affiliation(s)
- Primavera A Spagnolo
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | - David Goldman
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
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103
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Impulse control disorders and levodopa-induced dyskinesias in Parkinson's disease: an update. Lancet Neurol 2017; 16:238-250. [DOI: 10.1016/s1474-4422(17)30004-2] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/28/2016] [Accepted: 01/06/2017] [Indexed: 02/03/2023]
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104
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Medical Management of Parkinson's Disease after Initiation of Deep Brain Stimulation. Can J Neurol Sci 2017; 43:626-34. [PMID: 27670207 DOI: 10.1017/cjn.2016.274] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In this review, we have gathered all the available evidence to guide medication management after deep brain stimulation (DBS) in Parkinson's disease (PD). Surprisingly, we found that almost no study addressed drug-based management in the postoperative period. Dopaminergic medications are usually reduced, but whether the levodopa or dopamine agonist is to be reduced is left to the personal preference of the treating physician. We have summarized the pros and cons of both approaches. No study on the management of cognitive problems after DBS has been done, and only a few studies have explored the pharmacological management of such DBS-resistant symptoms as voice (amantadine), balance (donepezil) or gait disorders (amantadine, methylphenidate). As for the psychiatric problems so frequently reported in PD patients, researchers have directed their attention to the complex interplay between stimulation and reduction of dopaminergic drugs only recently. In conclusion, studies addressing medical management following DBS are still needed and will certainly contribute to the ultimate success of DBS procedures.
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105
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Krack P, Martinez-Fernandez R, del Alamo M, Obeso JA. Current applications and limitations of surgical treatments for movement disorders. Mov Disord 2017; 32:36-52. [DOI: 10.1002/mds.26890] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/10/2016] [Accepted: 11/13/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
- Paul Krack
- Neurology Division, Department of Clinical Neurosciences; University Hospital of Geneva; Geneva Switzerland
| | | | - Marta del Alamo
- CINAC-Hospital Universitario HM Puerta del Sur; CEU-San Pablo University; Madrid Spain
- Neurosurgery Department; Hospital Universitario Ramon y Cajal; Madrid Spain
| | - Jose A. Obeso
- CINAC-Hospital Universitario HM Puerta del Sur; CEU-San Pablo University; Madrid Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas; Madrid Spain
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106
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Rieu I, Houeto JL, Pereira B, De Chazeron I, Bichon A, Chéreau I, Ulla M, Brefel-Courbon C, Ory-Magne F, Dujardin K, Tison F, Krack P, Durif F. Impact of Mood and Behavioral Disorders on Quality of Life in Parkinson's disease. JOURNAL OF PARKINSONS DISEASE 2017; 6:267-77. [PMID: 27003781 DOI: 10.3233/jpd-150747] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mood symptoms negatively affect quality of life of Parkinson's disease (PD); however little is known about the impact of behavioral disorders such as impulse control disorders, and non-motor fluctuations on quality of life. OBJECTIVE To assess the impact of mood and behavioral disorders on quality of life in PD. METHODS 136 (84% male) PD were included (mean age: 61 ± 8y; mean duration of disease: 8.8 ± 5.4y). Mood symptoms, behavioral disorders and non-motor fluctuations were detected and quantified using the recently validated "Ardouin Scale of Behavior in Parkinson's Disease". Motor symptoms were assessed using UPDRS and quality of life with the "39-item Parkinson's Disease Questionnaire". RESULTS Both motor and non-motor factors significantly affected the quality of life of PD patients. Multivariate regression of the relationship between items of the quality of life questionnaire and the Ardouin Scale showed that alteration of patients' quality of life was strongly correlated with the presence of mood symptoms (such as depression, anxiety ...) and with non-motor fluctuations (especially in the OFF period). A significant correlation was also found between the number of symptoms and their severity, and the quality of life deterioration. Some behavioral disorders (compulsive buying / eating behavior) also negatively affected patient's quality of life to a lesser extent. Alternatively, excess in motivation and hobbyism behaviors had a positive impact on mobility and emotional well-being dimensions respectively of quality of life. CONCLUSIONS This study shows the main impact of mood symptoms and non-motor fluctuations on worsening quality of life in PD.
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Affiliation(s)
- Isabelle Rieu
- CHU Clermont-Ferrand, Department of Neurology, CHU Gabriel Montpied, Clermont-Ferrand, France.,Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
| | - Jean Luc Houeto
- Department Neurology, CIC INSERM-0802, CHU de Poitiers 86021 Poitiers cedex; INSERM U 1084, Laboratoire de Neurosciences Expérimentales et Cliniques, Université de Poitiers, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, DRCI, Biostatistics Unit, Clermont-Ferrand, France
| | - Ingrid De Chazeron
- Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Department of Psychiatry B, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Amélie Bichon
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University and INSERM, Unité 836, Grenoble Institut des Neurosciences, 38043 Grenoble, France
| | - Isabelle Chéreau
- CHU Clermont-Ferrand, Department of Psychiatry B, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Miguel Ulla
- CHU Clermont-Ferrand, Department of Neurology, CHU Gabriel Montpied, Clermont-Ferrand, France.,Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
| | | | - Fabienne Ory-Magne
- University, Hospital Toulouse, Neurology department, CHU Purpan, Toulouse, France
| | - Kathy Dujardin
- Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
| | - François Tison
- University of Bordeaux, Institut des Maladies Neurodégénératives, CNRS UMR 5293 et CHU de Bordeaux, France
| | - Paul Krack
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University and INSERM, Unité 836, Grenoble Institut des Neurosciences, 38043 Grenoble, France
| | - Franck Durif
- CHU Clermont-Ferrand, Department of Neurology, CHU Gabriel Montpied, Clermont-Ferrand, France.,Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
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107
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Kurtis MM, Rajah T, Delgado LF, Dafsari HS. The effect of deep brain stimulation on the non-motor symptoms of Parkinson's disease: a critical review of the current evidence. NPJ Parkinsons Dis 2017; 3:16024. [PMID: 28725706 PMCID: PMC5516616 DOI: 10.1038/npjparkd.2016.24] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/15/2016] [Accepted: 09/26/2016] [Indexed: 12/31/2022] Open
Abstract
The benefit of deep brain stimulation (DBS) in controlling the motor symptoms of Parkinson's disease is well established, however, the impact on the non-motor symptoms (NMS) remains to be elucidated, although the growing investigative efforts are promising. This article reviews the reported data and considers the level of evidence available with regard to the effect of DBS on NMS total burden and on the cognitive, neuropsychiatric, sleep, pain, dysautonomic, and weight domains. Multiple case series suggest that DBS improves the burden of NMS by reducing prevalence, intensity, and non-motor fluctuations. There is level I evidence on the effect of DBS on cognition and mood. Slight cognitive decline has been reported in most class I studies, although the functional effect is probably minimal. Two randomized prospective studies reported no change in depression while improvement of anxiety has been reported by a class I trial. Prospective cohort studies point to improvement of hyperdopaminergic behaviors, such as impulse control disorders, while others report that hypodopaminergic states, like apathy, can appear after DBS. There is only class III evidence supporting the benefit of DBS on other NMS such as nocturnal sleep, pain, dysautonomia (urinary, gastrointestinal, cardiovascular, and sweating), and weight loss. Although preliminary results are promising, randomized prospectively controlled trials with NMS as primary end points are necessary to further explore the effect of DBS on these often invalidating symptoms and offer conclusions about efficacy.
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Affiliation(s)
- Mónica M Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Thadshani Rajah
- Kings Parkinson's Centre of Excellence, Kings College and Kings College Hospital, London, UK
| | - Luisa F Delgado
- Fundación Universitaria de Ciencias de la Salud, Hospital San José—Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Haidar S Dafsari
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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108
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Kasemsuk C, Oyama G, Hattori N. Management of impulse control disorders with deep brain stimulation: A double-edged sword. J Neurol Sci 2017; 374:63-68. [PMID: 28126343 DOI: 10.1016/j.jns.2017.01.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 12/29/2022]
Abstract
Deep brain stimulation (DBS) is a surgical option for advanced Parkinson's disease. Although DBS is used to treat motor fluctuation, DBS may affect non-motor symptoms including mood disorders, cognitive dysfunction, and behavior problems. Impulse control disorders (ICDs) are abnormal behaviors with various manifestations such as pathological gambling, hypersexuality, compulsive shopping, and binge eating, which can affect the quality of life in patients with Parkinson's disease. The effect of DBS on ICD is controversial. Reducing medication by DBS may improve ICDs, however, worsening or even developing new ICDs after DBS can occur. We will review the impact of DBS on ICDs and reveal factors associated with a good response to DBS as well as risk factors for developing ICDs after DBS. We also propose a strategy to manage preexisting ICD and prevent postoperative de novo ICDs.
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Affiliation(s)
- Chayut Kasemsuk
- Department of Neurology, Juntendo University, Faculty of Medicine, Tokyo, Japan; Department of Neurology, Prasat Neurological Institute, Bangkok, Thailand
| | - Genko Oyama
- Department of Neurology, Juntendo University, Faculty of Medicine, Tokyo, Japan.
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University, Faculty of Medicine, Tokyo, Japan
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109
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Pagonabarraga J, Kulisevsky J. Apathy in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:657-678. [DOI: 10.1016/bs.irn.2017.05.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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110
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Hogg E, Wertheimer J, Graner S, Tagliati M. Deep Brain Stimulation and Nonmotor Symptoms. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1045-1089. [DOI: 10.1016/bs.irn.2017.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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111
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Merkl A, Röck E, Schmitz-Hübsch T, Schneider GH, Kühn AA. Effects of subthalamic nucleus deep brain stimulation on emotional working memory capacity and mood in patients with Parkinson's disease. Neuropsychiatr Dis Treat 2017; 13:1603-1611. [PMID: 28684915 PMCID: PMC5485890 DOI: 10.2147/ndt.s126397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In Parkinson's disease (PD), cognitive symptoms and mood changes may be even more distressing for the patient than motor symptoms. OBJECTIVE Our aim was to determine the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on working memory (WM) and mood. METHODS Sixteen patients with PD were assessed with STN-DBS switched on (DBS-ON) and with dopaminergic treatment (Med-ON) compared to switched off (DBS-OFF) and without dopaminergic treatment (Med-OFF). The primary outcome measures were a Visual Analog Mood Scale (VAMS) and an emotional 2-back WM task at 12 months after DBS in the optimal DBS-ON/Med-ON setting compared to DBS-OFF/Med-OFF. RESULTS Comparison of DBS-OFF/Med-OFF to DBS-ON/Med-ON revealed a significant increase in alertness (meanoff/off =51.59±24.54; meanon/on =72.75; P=0.016) and contentedness (meanoff/off =38.73±24.41; meanon/on =79.01±17.66; P=0.001, n=16), and a trend for reduction in sedation (P=0.060), which was related to stimulation as shown in a subgroup of seven patients. The N-back task revealed a significant increase in accuracy with DBS-ON/Med-ON compared to DBS-OFF/Med-OFF (82.0% vs 76.0%, respectively) (P=0.044), regardless of stimulus valence. CONCLUSION In line with previous studies, we found that patients rated themselves subjectively as more alert, content, and less sedated during short-term DBS-ON. Accuracy in the WM task increased with the combination of DBS and medication, possibly related to higher alertness of the patients. Our results add to the currently mixed results described for DBS on WM and suggest that there are no deleterious DBS effects on this specific cognitive domain.
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Affiliation(s)
- Angela Merkl
- Department of Neurology, Charité - University Medicine Berlin, Campus Virchow Klinikum.,Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Campus Benjamin Franklin
| | - Eva Röck
- Department of Neurology, Charité - University Medicine Berlin, Campus Virchow Klinikum
| | - Tanja Schmitz-Hübsch
- Department of Neurology, Charité - University Medicine Berlin, Campus Virchow Klinikum.,NeuroCure, Charité - University Medicine Berlin
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - University Medicine Berlin, Campus Virchow Klinikum
| | - Andrea A Kühn
- Department of Neurology, Charité - University Medicine Berlin, Campus Virchow Klinikum.,NeuroCure, Charité - University Medicine Berlin.,Berlin School of Mind and Brain, Charité - University Medicine Berlin, Berlin, Germany
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112
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Voon V, Droux F, Morris L, Chabardes S, Bougerol T, David O, Krack P, Polosan M. Decisional impulsivity and the associative-limbic subthalamic nucleus in obsessive-compulsive disorder: stimulation and connectivity. Brain 2016; 140:442-456. [PMID: 28040671 PMCID: PMC5278307 DOI: 10.1093/brain/aww309] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/11/2016] [Accepted: 10/21/2016] [Indexed: 12/17/2022] Open
Abstract
Why do we make hasty decisions for short-term gain? Rapid decision-making with limited accumulation of evidence and delay discounting are forms of decisional impulsivity. The subthalamic nucleus is implicated in inhibitory function but its role in decisional impulsivity is less well-understood. Here we assess decisional impulsivity in subjects with obsessive compulsive disorder who have undergone deep brain stimulation of the limbic and associative subthalamic nucleus. We show that stimulation of the subthalamic nucleus is causally implicated in increasing decisional impulsivity with less accumulation of evidence during probabilistic uncertainty and in enhancing delay discounting. Subthalamic stimulation shifts evidence accumulation in subjects with obsessive-compulsive disorder towards a functional less cautious style closer to that of healthy controls emphasizing its adaptive nature. Thus, subjects with obsessive compulsive disorder on subthalamic stimulation may be less likely to check for evidence (e.g. checking that the stove is on) with no difference in subjective confidence (or doubt). In a separate study, we replicate in humans (154 healthy controls) using resting state functional connectivity, tracing studies conducted in non-human primates dissociating limbic, associative and motor frontal hyper-direct connectivity with anterior and posterior subregions of the subthalamic nucleus. We show lateralization of functional connectivity of bilateral ventral striatum to right anterior ventromedial subthalamic nucleus consistent with previous observations of lateralization of emotionally evoked activity to right ventral subthalamic nucleus. We use a multi-echo sequence with independent components analysis, which has been shown to have enhanced signal-to-noise ratio, thus optimizing visualization of small subcortical structures. These findings in healthy controls converge with the effective contacts in obsessive compulsive disorder patients localized within the anterior and ventral subthalamic nucleus. We further show that evidence accumulation is associated with anterior associative-limbic subthalamic nucleus and right dorsolateral prefrontal functional connectivity in healthy controls, a region implicated in decision-making under uncertainty. Together, our findings highlight specificity of the anterior associative-limbic subthalamic nucleus in decisional impulsivity. Given increasing interest in the potential for subthalamic stimulation in psychiatric disorders and the neuropsychiatric symptoms of Parkinson’s disease, these findings have clinical implications for behavioural symptoms and cognitive effects as a function of localization of subthalamic stimulation.
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Affiliation(s)
- Valerie Voon
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK .,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Fabien Droux
- Univ. Grenoble Alpes, Inserm U1216 Grenoble Institute of Neuroscience, CHU Grenoble Alpes, F-38000 Grenoble, France
| | - Laurel Morris
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Stephan Chabardes
- Univ. Grenoble Alpes, Inserm U1216 Grenoble Institute of Neuroscience, CHU Grenoble Alpes, F-38000 Grenoble, France
| | - Thierry Bougerol
- Univ. Grenoble Alpes, Inserm U1216 Grenoble Institute of Neuroscience, CHU Grenoble Alpes, F-38000 Grenoble, France
| | - Olivier David
- Univ. Grenoble Alpes, Inserm U1216 Grenoble Institute of Neuroscience, CHU Grenoble Alpes, F-38000 Grenoble, France
| | - Paul Krack
- Univ. Grenoble Alpes, Inserm U1216 Grenoble Institute of Neuroscience, CHU Grenoble Alpes, F-38000 Grenoble, France.,Department of Clinical Neurosciences; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mircea Polosan
- Univ. Grenoble Alpes, Inserm U1216 Grenoble Institute of Neuroscience, CHU Grenoble Alpes, F-38000 Grenoble, France
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113
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Wang XH, Zhang L, Sperry L, Olichney J, Farias ST, Shahlaie K, Chang NM, Liu Y, Wang SP, Wang C. Target Selection Recommendations Based on Impact of Deep Brain Stimulation Surgeries on Nonmotor Symptoms of Parkinson's Disease. Chin Med J (Engl) 2016; 128:3371-80. [PMID: 26668154 PMCID: PMC4797515 DOI: 10.4103/0366-6999.171464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE This review examines the evidence that deep brain stimulation (DBS) has extensive impact on nonmotor symptoms (NMSs) of patients with Parkinson's disease (PD). DATA SOURCES We retrieved information from the PubMed database up to September, 2015, using various search terms and their combinations including PD, NMSs, DBS, globus pallidus internus (GPi), subthalamic nucleus (STN), and ventral intermediate thalamic nucleus. STUDY SELECTION We included data from peer-reviewed journals on impacts of DBS on neuropsychological profiles, sensory function, autonomic symptoms, weight changes, and sleep disturbances. For psychological symptoms and cognitive impairment, we tried to use more reliable proofs: Random, control, multicenter, large sample sizes, and long period follow-up clinical studies. We categorized the NMSs into four groups: those that would improve definitively following DBS; those that are not significantly affected by DBS; those that remain controversial on their surgical benefit; and those that can be worsened by DBS. RESULTS In general, it seems to be an overall beneficial effect of DBS on NMSs, such as sensory, sleep, gastrointestinal, sweating, cardiovascular, odor, urological symptoms, and sexual dysfunction, GPi-DBS may produce similar results; Both STN and Gpi-DBS are safe with regard to cognition and psychology over long-term follow-up, though verbal fluency decline is related to DBS; The impact of DBS on behavioral addictions and dysphagia is still uncertain. CONCLUSIONS As the motor effects of STN-DBS and GPi-DBS are similar, NMSs may determine the target choice in surgery of future patients.
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Affiliation(s)
- Xiao-Hong Wang
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, Liaoning 116033, China
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114
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Mulders AEP, Plantinga BR, Schruers K, Duits A, Janssen MLF, Ackermans L, Leentjens AFG, Jahanshahi A, Temel Y. Deep brain stimulation of the subthalamic nucleus in obsessive-compulsive disorder: Neuroanatomical and pathophysiological considerations. Eur Neuropsychopharmacol 2016; 26:1909-1919. [PMID: 27838106 DOI: 10.1016/j.euroneuro.2016.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/04/2016] [Accepted: 10/29/2016] [Indexed: 11/17/2022]
Abstract
Obsessive-compulsive disorder (OCD) is among the most disabling chronic psychiatric disorders and has a significant negative impact on multiple domains of quality of life. For patients suffering from severe refractory OCD, deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been applied. Reviewing the literature of the last years we believe that through its central position within the cortico-basal ganglia-thalamocortical circuits, the STN has a coordinating role in decision-making and action-selection mechanisms. Dysfunctional information-processing at the level of the STN is responsible for some of the core symptoms of OCD. Research confirms an electrophysiological dysfunction in the associative and limbic (non-motor) parts of the STN. Compared to Parkinson׳s disease patients, STN neurons in OCD exhibit a lower firing rate, less frequent but longer bursts, increased burst activity in the anterior ventromedial area, an asymmetrical left-sided burst distribution, and a predominant oscillatory activity in the δ-band. Moreover, there is direct evidence for the involvement of the STN in both checking behavior and OCD symptoms, which are both related to changes in electrophysiological activity in the non-motor STN. Through a combination of mechanisms, DBS of the STN seems to interrupt the disturbed information-processing, leading to a normalization of connectivity within the cortico-basal ganglia-thalamocortical circuits and consequently to a reduction in symptoms. In conclusion, based on the STN׳s strategic position within cortico-basal ganglia-thalamocortical circuits and its involvement in action-selection mechanisms that are responsible for some of the core symptoms of OCD, the STN is a mechanism-based target for DBS in OCD.
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Affiliation(s)
- A E P Mulders
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - B R Plantinga
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Biomedical Image Analysis, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - K Schruers
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Duits
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M L F Janssen
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L Ackermans
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A F G Leentjens
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Jahanshahi
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Y Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
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115
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Baumann A, Moreira CG, Morawska MM, Masneuf S, Baumann CR, Noain D. Preliminary Evidence of Apathetic-Like Behavior in Aged Vesicular Monoamine Transporter 2 Deficient Mice. Front Hum Neurosci 2016; 10:587. [PMID: 27917116 PMCID: PMC5114272 DOI: 10.3389/fnhum.2016.00587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 11/03/2016] [Indexed: 12/02/2022] Open
Abstract
Apathy is considered to be a core feature of Parkinson’s disease (PD) and has been associated with a variety of states and symptoms of the disease, such as increased severity of motor symptoms, impaired cognition, executive dysfunction and dementia. Apart from the high prevalence of apathy in PD, which is estimated to be about 40%, the underlying pathophysiology remains poorly understood and current treatment approaches are unspecific and proved to be only partially effective. In animal models, apathy has been sub-optimally modeled, mostly by means of pharmacological and stress-induced methods, whereby concomitant depressive-like symptoms could not be ruled out. In the context of PD only a few studies on toxin-based models (i.e., 6-hydroxydopamine (6-OHDA) or 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)) claimed to have determined apathetic symptoms in animals. The assessment of apathetic symptoms in more elaborated and multifaceted genetic animal models of PD could help to understand the pathophysiological development of apathy in PD and eventually advance specific treatments for afflicted patients. Here we report the presence of behavioral signs of apathy in 12 months old mice that express only ~5% of the vesicular monoamine transporter 2 (VMAT2). Apathetic-like behavior in VMAT2 deficient (LO) mice was evidenced by impaired burrowing and nest building skills, and a reduced preference for sweet solution in the saccharin preference test, while the performance in the forced swimming test was normal. Our preliminary results suggest that VMAT2 deficient mice show an apathetic-like phenotype that might be independent of depressive-like symptoms. Therefore VMAT2 LO mice could be a useful tool to study the pathophysiological substrates of apathy and to test novel treatment strategies for apathy in the context of PD.
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Affiliation(s)
- Aron Baumann
- Department of Neurology, University Hospital of Zurich Zurich, Switzerland
| | - Carlos G Moreira
- Department of Neurology, University Hospital of Zurich Zurich, Switzerland
| | - Marta M Morawska
- Department of Neurology, University Hospital of Zurich Zurich, Switzerland
| | - Sophie Masneuf
- Department of Neurology, University Hospital of Zurich Zurich, Switzerland
| | | | - Daniela Noain
- Department of Neurology, University Hospital of Zurich Zurich, Switzerland
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UMEMURA A, OYAMA G, SHIMO Y, NAKAJIMA M, NAKAJIMA A, JO T, SEKIMOTO S, ITO M, MITSUHASHI T, HATTORI N, ARAI H. Current Topics in Deep Brain Stimulation for Parkinson Disease. Neurol Med Chir (Tokyo) 2016; 56:613-625. [PMID: 27349658 PMCID: PMC5066082 DOI: 10.2176/nmc.ra.2016-0021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/04/2016] [Indexed: 01/30/2023] Open
Abstract
There is a long history of surgical treatment for Parkinson disease (PD). After pioneering trials and errors, the current primary surgical treatment for PD is deep brain stimulation (DBS). DBS is a promising treatment option for patients with medically refractory PD. However, there are still many problems and controversies associated with DBS. In this review, we discuss current issues in DBS for PD, including patient selection, clinical outcomes, complications, target selection, long-term outcomes, management of axial symptoms, timing of surgery, surgical procedures, cost-effectiveness, and new technology.
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Affiliation(s)
- Atsushi UMEMURA
- Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Genko OYAMA
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasushi SHIMO
- Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Madoka NAKAJIMA
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Asuka NAKAJIMA
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takayuki JO
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoko SEKIMOTO
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masanobu ITO
- Department of Psychiatry, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takumi MITSUHASHI
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobutaka HATTORI
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hajime ARAI
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
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117
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Klein E. Informed Consent in Implantable BCI Research: Identifying Risks and Exploring Meaning. SCIENCE AND ENGINEERING ETHICS 2016; 22:1299-1317. [PMID: 26497727 DOI: 10.1007/s11948-015-9712-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
Implantable brain-computer interface (BCI) technology is an expanding area of engineering research now moving into clinical application. Ensuring meaningful informed consent in implantable BCI research is an ethical imperative. The emerging and rapidly evolving nature of implantable BCI research makes identification of risks, a critical component of informed consent, a challenge. In this paper, 6 core risk domains relevant to implantable BCI research are identified-short and long term safety, cognitive and communicative impairment, inappropriate expectations, involuntariness, affective impairment, and privacy and security. Work in deep brain stimulation provides a useful starting point for understanding this core set of risks in implantable BCI. Three further risk domains-risks pertaining to identity, agency, and stigma-are identified. These risks are not typically part of formalized consent processes. It is important as informed consent practices are further developed for implantable BCI research that attention be paid not just to disclosing core research risks but exploring the meaning of BCI research with potential participants.
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Affiliation(s)
- Eran Klein
- Department of Philosophy and Center for Sensorimotor Neural Engineering, University of Washington, Seattle, WA, USA.
- Department of Neurology, Oregon Health and Sciences University, Portland, OR, USA.
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118
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Abstract
BACKGROUND Impulse control disorders (ICDs) have become a widely recognized non-motor complication of Parkinson's disease (PD) in patients taking dopamine replacement therapy (DRT). There are no current evidence-based recommendations for their treatment, other than reducing their dopaminergic medication. METHODS This study reviews the current literature of the treatment of ICDs including pharmacological treatments, deep brain stimulation, and psychotherapeutic interventions. RESULTS Dopamine agonist withdrawal is the most common and effective treatment, but may lead to an aversive withdrawal syndrome or motor symptom degeneration in some individuals. There is insufficient evidence for all other pharmacological treatments in treating ICDs in PD, including amantadine, serotonin selective reuptake inhibitors, antipsychotics, anticonvulsants, and opioid antagonists (e.g. naltrexone). Large randomized control trials need to be performed before these drugs can be routinely used for the treatment of ICDs in PD. Deep brain stimulation remains equivocal because ICD symptoms resolve in some patients after surgery but may appear de novo in others. Cognitive behavioral therapy has been shown to improve ICD symptoms in the only published study, although further research is urgently needed. CONCLUSIONS Further research will allow for the development of evidence-based guidelines for the management of ICDs in PD.
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Abstract
Cognitive and neuropsychiatric symptoms are common in Parkinson's Disease and may surpass motor symptoms as the major factors impacting patient quality of life. The symptoms may be broadly separated into those associated with the disease process and those that represent adverse effects of treatment. Symptoms attributed to the disease arise from pathologic changes within multiple brain regions and are not restricted to dysfunction in the dopaminergic system. Mood symptoms such as depression, anxiety, and apathy are common and may precede the development of motor symptoms by years, while other neuropsychiatric symptoms such as cognitive impairment, dementia, and psychosis are more common in later stages of the disease. Neuropsychiatric symptoms attributed to treatment include impulse control disorders, pathologic use of dopaminergic medications, and psychosis. This manuscript will review the current understanding of neuropsychiatric symptoms in Parkinson's Disease.
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Affiliation(s)
- Jeffrey W Cooney
- Duke University School of Medicine, 932 Morreene Rd., Durham, NC, 27705, USA
| | - Mark Stacy
- Duke University School of Medicine, 120a Davison, Durham, NC, 27705, USA.
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Seymour B, Barbe M, Dayan P, Shiner T, Dolan R, Fink GR. Deep brain stimulation of the subthalamic nucleus modulates sensitivity to decision outcome value in Parkinson's disease. Sci Rep 2016; 6:32509. [PMID: 27624437 PMCID: PMC5021944 DOI: 10.1038/srep32509] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 08/03/2016] [Indexed: 01/13/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus in Parkinson’s disease is known to cause a subtle but important adverse impact on behaviour, with impulsivity its most widely reported manifestation. However, precisely which computational components of the decision process are modulated is not fully understood. Here we probe a number of distinct subprocesses, including temporal discount, outcome utility, instrumental learning rate, instrumental outcome sensitivity, reward-loss trade-offs, and perseveration. We tested 22 Parkinson’s Disease patients both on and off subthalamic nucleus deep brain stimulation (STN-DBS), while they performed an instrumental learning task involving financial rewards and losses, and an inter-temporal choice task for financial rewards. We found that instrumental learning performance was significantly worse following stimulation, due to modulation of instrumental outcome sensitivity. Specifically, patients became less sensitive to decision values for both rewards and losses, but without any change to the learning rate or reward-loss trade-offs. However, we found no evidence that DBS modulated different components of temporal impulsivity. In conclusion, our results implicate the subthalamic nucleus in a modulation of outcome value in experience-based learning and decision-making in Parkinson’s disease, suggesting a more pervasive role of the subthalamic nucleus in the control of human decision-making than previously thought.
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Affiliation(s)
- Ben Seymour
- Computational and Biological Learning Lab, Department of Engineering, University of Cambridge, UK.,Wellcome Trust Centre for Neuroimaging, UCL, London, UK.,Center for Information and Neural Networks, National Institute for Information and Communications Technology, Japan
| | - Michael Barbe
- Department of Neurology, University Hospital, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre, Jülich, Germany
| | - Peter Dayan
- Gatsby Computational Neuroscience Unit, UCL, London, UK
| | - Tamara Shiner
- Wellcome Trust Centre for Neuroimaging, UCL, London, UK
| | - Ray Dolan
- Wellcome Trust Centre for Neuroimaging, UCL, London, UK
| | - Gereon R Fink
- Department of Neurology, University Hospital, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre, Jülich, Germany
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Abstract
Parkinson disease (PD) is a common neurodegenerative disorder in older adults characterized by motor and nonmotor symptoms and complications. Impulse control disorders (ICDs), such as pathological gambling, compulsive shopping, compulsive sexual behavior (hypersexuality), and binge eating disorder, affect 13.6% of the PD population. Use of dopamine receptor agonists (DRAs) is considered a major risk factor for ICD development. Amantadine and a high dose of levodopa were linked to ICDs to a lesser extent than DRAs. Based on the severity of behavior(s), ICDs can negatively impact social, professional, and familial lives of patients and their families. Ideally, all PD patients taking DRAs, high doses of levodopa, and/or amantadine should be routinely asked about or monitored for ICDs during therapy initiation and continuation. Dose decrease or withdrawal of the offending agent, primarily DRAs, is usually the most effective first step in ICD management. Careful dose adjustment with close monitoring is warranted due to risk for worsening of motor symptoms or emergence of dopamine agonist withdrawal syndrome (DAWS). About 1/3 of PD patients with ICD who decrease or discontinue DRA experienced DAWS. The lowest dose of DRA will need to be continued to balance ICDs and DAWS as it is not alleviated by other dopaminergic or psychotropic medications. Other therapies with low empiric evidence, such as amantadine, naloxone, cognitive behavior therapy, deep brain stimulation, and psychopharmacotherapy showed mixed results for ICD management. It is crucial that clinicians are familiar with the psychiatric complications of PD, including ICDs, beyond mere recognition and management of motor symptoms.
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Affiliation(s)
- Marketa Marvanova
- Chair and Associate Professor, Pharmacy Practice Department, College of Health Professions, North Dakota State University, Fargo, North Dakota,
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122
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Deffains M, Iskhakova L, Katabi S, Haber SN, Israel Z, Bergman H. Subthalamic, not striatal, activity correlates with basal ganglia downstream activity in normal and parkinsonian monkeys. eLife 2016; 5. [PMID: 27552049 PMCID: PMC5030093 DOI: 10.7554/elife.16443] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/22/2016] [Indexed: 02/02/2023] Open
Abstract
The striatum and the subthalamic nucleus (STN) constitute the input stage of the basal ganglia (BG) network and together innervate BG downstream structures using GABA and glutamate, respectively. Comparison of the neuronal activity in BG input and downstream structures reveals that subthalamic, not striatal, activity fluctuations correlate with modulations in the increase/decrease discharge balance of BG downstream neurons during temporal discounting classical condition task. After induction of parkinsonism with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), abnormal low beta (8-15 Hz) spiking and local field potential (LFP) oscillations resonate across the BG network. Nevertheless, LFP beta oscillations entrain spiking activity of STN, striatal cholinergic interneurons and BG downstream structures, but do not entrain spiking activity of striatal projection neurons. Our results highlight the pivotal role of STN divergent projections in BG physiology and pathophysiology and may explain why STN is such an effective site for invasive treatment of advanced Parkinson's disease and other BG-related disorders. DOI:http://dx.doi.org/10.7554/eLife.16443.001 The symptoms of Parkinson’s disease include tremor and slow movement, as well as loss of balance, depression and problems with sleep and memory. The death of neurons in a region of the brain called the substantia nigra pars compacta is one of the major hallmarks of Parkinson’s disease. These neurons produce a chemical called dopamine, and their death reduces dopamine levels in another area of the brain called the striatum. This structure is one of five brain regions known collectively as the basal ganglia, which form a circuit that helps to control movement. The most effective treatment currently available for advanced Parkinson’s disease entails lowering electrodes deep into the brain in order to shut down the activity of part of the basal ganglia. However, the target is not the striatum; instead it is a structure called the subthalamic nucleus. The striatum and the subthalamic nucleus are the two input regions of the basal ganglia: each sends signals to the other three structures downstream. So why does targeting the subthalamic nucleus, but not the striatum, reduce the symptoms of Parkinson’s disease? To shed some light on this issue, Deffains et al. recorded the activity of neurons in the basal ganglia before and after injecting two monkeys with a drug called MPTP. Related to heroin, MPTP produces symptoms in animals that resemble those of Parkinson’s disease. Before the injections, spontaneous fluctuations in the activity of the subthalamic nucleus produced matching changes in the activity of the three downstream basal ganglia structures. Fluctuations in the activity of the striatum, by contrast, had no such effect. Moreover, injecting the monkeys with MPTP caused the basal ganglia to fire in an abnormal highly synchronized rhythm, similar to that seen in Parkinson’s disease. Crucially, the subthalamic nucleus contributed to this abnormal rhythm, whereas the striatum did not. The results presented by Deffains et al. provide a concrete explanation for why inactivating the subthalamic nucleus, but not the striatum, reduces the symptoms of Parkinson’s disease. Further research is now needed to explore how the striatum controls the activity of downstream regions of the basal ganglia, both in healthy people and in those with Parkinson's disease. DOI:http://dx.doi.org/10.7554/eLife.16443.002
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Affiliation(s)
- Marc Deffains
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - Liliya Iskhakova
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - Shiran Katabi
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Suzanne N Haber
- Department of Pharmacology and Physiology, University of Rochester School of Medicine, Rochester, United States
| | - Zvi Israel
- Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
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123
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Deep brain stimulation and sleep-wake functions in Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2016; 32:12-19. [PMID: 27605426 DOI: 10.1016/j.parkreldis.2016.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/19/2016] [Accepted: 08/05/2016] [Indexed: 01/27/2023]
Abstract
Sleep-wake disturbances (SWD) are common nonmotor symptoms (NMS) and have a great impact on quality of life of patients with Parkinson's disease (PD). Deep brain stimulation (DBS) is an established treatment in PD. While the beneficial effects of DBS on cardinal PD motor symptoms are indisputable, the data for several NMS, including sleep-wake functions, are limited and often controversial. Our primary objective was to review the literature on the impact of DBS on sleep-wake functions in patients with PD. A systematic review of articles, published in PubMed between January 1st, 2000 and December 31st, 2015 was performed to identify studies addressing the evolution of sleep-wake functions after DBS in patients with PD. Only 38 of 208 studies, involving a total of 1443 subjects, met the inclusion criteria. Most of them reported a positive effect of subthalamic DBS on sleep quality and consequently on quality of life. Seven studies used polysomnography to objectively assess sleep parameters. The data concerning subthalamic DBS and wake functions are controversial and studies using objective, laboratory-based measures for the assessment of wake functions are lacking. Very few studies assessed the impact of other DBS targets (e.g. pallidal stimulation) on SWD. Further prospective observational DBS studies assessing subjectively and objectively specific sleep-wake parameters in patients with PD are needed.
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Sierra M, Carnicella S, Strafella AP, Bichon A, Lhommée E, Castrioto A, Chabardes S, Thobois S, Krack P. Apathy and Impulse Control Disorders: Yin & Yang of Dopamine Dependent Behaviors. JOURNAL OF PARKINSONS DISEASE 2016; 5:625-36. [PMID: 25870025 DOI: 10.3233/jpd-150535] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Neuropsychiatric symptoms are common non-motor symptoms in Parkinson's disease (PD). Apathy and impulse control disorders (ICD) are two opposite motivational expressions of a continuous behavioural spectrum involving hypo- and hyperdopaminergia. Both syndromes share pathological (decreased vs increased) dopamine receptor stimulation states. Apathy belongs to the spectrum of hypodopaminergic symptoms together with anhedonia, anxiety and depression. Apathy is a key symptom of PD which worsens with disease progression. Animal models, imaging and pharmacological studies concur in pointing out dopaminergic denervation in the aetiology of parkinsonian apathy with a cardinal role of decreased tonic D2/D3 receptor stimulation. ICDs are part of the hyperdopaminergic behavioural spectrum, which also includes punding, and dopamine dysregulation syndrome (DDS), which are all related to non-physiological dopaminergic stimulation induced by antiparkinsonian drugs. According to clinical data tonic D2/D3 receptor stimulation can be sufficient to induce ICDs. Clinical observations in drug addiction and PD as well as data from studies in dopamine depleted rodents provide hints allowing to argue that both pulsatile D1 and D2 receptor stimulation and the severity of dopaminergic denervation are risk factors to develop punding behavior and DDS. Imaging studies have shown that the brain structures involved in drug addiction are also involved in hyperdopaminergic behaviours with increase of bottom-up appetitive drive and decrease in prefrontal top down behavioural control.
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Affiliation(s)
- María Sierra
- Service of Neurology, University Hospital "Marqués de Valdecilla (IFIMAV)", University of Cantabria and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
| | | | - Antonio P Strafella
- Morton and Gloria Shulman Movement Disorder Unit - E.J. Safra Parkinson Disease Program, Toronto Western Hospital and Research Institute, UHN & Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Ontario, Canada
| | - Amélie Bichon
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble Universités, France; and INSERM, Unit 836, Grenoble Institut des Neurosciences, Grenoble, France
| | - Eugénie Lhommée
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble Universités, France; and INSERM, Unit 836, Grenoble Institut des Neurosciences, Grenoble, France
| | - Anna Castrioto
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble Universités, France; and INSERM, Unit 836, Grenoble Institut des Neurosciences, Grenoble, France
| | - Stephan Chabardes
- Department of Neurosurgery CHU de Grenoble, Joseph Fourier University, Grenoble, France and INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France
| | - Stéphane Thobois
- Université de Lyon, F-69622, Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, UMR5229, Centre de Neuroscience Cognitive, Bron, France; Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Paul Krack
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble Universités, France; and INSERM, Unit 836, Grenoble Institut des Neurosciences, Grenoble, France
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Martínez-Fernández R, Schmitt E, Martinez-Martin P, Krack P. The hidden sister of motor fluctuations in Parkinson's disease: A review on nonmotor fluctuations. Mov Disord 2016; 31:1080-94. [PMID: 27431515 DOI: 10.1002/mds.26731] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 06/13/2016] [Accepted: 06/19/2016] [Indexed: 12/29/2022] Open
Abstract
Only a few years after the introduction of levodopa, the first descriptions of motor fluctuations and dyskinesia related to dopaminergic therapy appeared. In PD, attention turned to their management, that had dampened the euphoria of the "levodopa miracle." It soon became clear that neuropsychiatric, autonomic, and sensory features also tend to develop fluctuations after chronic exposure to l-dopa. The diversity of fluctuating nonmotor symptoms, their largely subjective nature, coupled with a frequent lack of insight led to difficulties in identification and quantification. This may explain why, despite the high impact of nonmotor symptoms on patient autonomy and quality of life, evaluation of nonmotor fluctuations is not part of clinical routine. In view of the lack of specific validated assessment tools, detailed anamnesis should ideally be coupled with an evaluation in both ON and OFF drug conditions. The mechanisms of nonmotor fluctuations are not well understood. It is thought that they share dopaminergic presynaptic pharmacokinetic and postsynaptic pharmacodynamic mechanisms with the classical motor complications, but involve different neural pathways. Although symptoms fluctuate with dopaminergic treatment, serotonine and norepinephrine denervation, as well as interactions between neurotransmitter systems, probably contribute to their diversity. The lack of validated tools for assessment of these phenomena explains the almost complete absence of treatment studies. Management, largely resulting from expert opinion, includes psychiatric follow-up, nondopaminergic drugs, and advanced dopaminergic treatment, including drug delivery pumps and DBS. This review aims to provide a starting point for the understanding, diagnosis, and management of nonmotor fluctuations. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes and Grenoble Institut des Neurosciences, INSERM U386, Grenoble, France
| | - Pablo Martinez-Martin
- National Center of Epidemiology, Carlos III Institute of Health and CIBERNED, Madrid, Spain
| | - Paul Krack
- Neurology Division, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
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Zénon A, Duclos Y, Carron R, Witjas T, Baunez C, Régis J, Azulay JP, Brown P, Eusebio A. The human subthalamic nucleus encodes the subjective value of reward and the cost of effort during decision-making. Brain 2016; 139:1830-43. [PMID: 27190012 DOI: 10.1093/brain/aww075] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/24/2016] [Indexed: 01/18/2023] Open
Abstract
Adaptive behaviour entails the capacity to select actions as a function of their energy cost and expected value and the disruption of this faculty is now viewed as a possible cause of the symptoms of Parkinson's disease. Indirect evidence points to the involvement of the subthalamic nucleus-the most common target for deep brain stimulation in Parkinson's disease-in cost-benefit computation. However, this putative function appears at odds with the current view that the subthalamic nucleus is important for adjusting behaviour to conflict. Here we tested these contrasting hypotheses by recording the neuronal activity of the subthalamic nucleus of patients with Parkinson's disease during an effort-based decision task. Local field potentials were recorded from the subthalamic nucleus of 12 patients with advanced Parkinson's disease (mean age 63.8 years ± 6.8; mean disease duration 9.4 years ± 2.5) both OFF and ON levodopa while they had to decide whether to engage in an effort task based on the level of effort required and the value of the reward promised in return. The data were analysed using generalized linear mixed models and cluster-based permutation methods. Behaviourally, the probability of trial acceptance increased with the reward value and decreased with the required effort level. Dopamine replacement therapy increased the rate of acceptance for efforts associated with low rewards. When recording the subthalamic nucleus activity, we found a clear neural response to both reward and effort cues in the 1-10 Hz range. In addition these responses were informative of the subjective value of reward and level of effort rather than their actual quantities, such that they were predictive of the participant's decisions. OFF levodopa, this link with acceptance was weakened. Finally, we found that these responses did not index conflict, as they did not vary as a function of the distance from indifference in the acceptance decision. These findings show that low-frequency neuronal activity in the subthalamic nucleus may encode the information required to make cost-benefit comparisons, rather than signal conflict. The link between these neural responses and behaviour was stronger under dopamine replacement therapy. Our findings are consistent with the view that Parkinson's disease symptoms may be caused by a disruption of the processes involved in balancing the value of actions with their associated effort cost.
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Affiliation(s)
- Alexandre Zénon
- 1 Institute of Neurosciences, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Yann Duclos
- 2 Institut de Neurosciences de La Timone UMR 7289, Aix Marseille Université, CNRS, 13385, Marseille, France
| | - Romain Carron
- 3 APHM, CHU Timone, Department of Functional and Stereotactic Neurosurgery, 13385, Marseille, France
| | - Tatiana Witjas
- 2 Institut de Neurosciences de La Timone UMR 7289, Aix Marseille Université, CNRS, 13385, Marseille, France 4 APHM, CHU Timone, Department of Neurology and Movement Disorders, 13385, Marseille, France
| | - Christelle Baunez
- 2 Institut de Neurosciences de La Timone UMR 7289, Aix Marseille Université, CNRS, 13385, Marseille, France
| | - Jean Régis
- 3 APHM, CHU Timone, Department of Functional and Stereotactic Neurosurgery, 13385, Marseille, France
| | - Jean-Philippe Azulay
- 2 Institut de Neurosciences de La Timone UMR 7289, Aix Marseille Université, CNRS, 13385, Marseille, France 4 APHM, CHU Timone, Department of Neurology and Movement Disorders, 13385, Marseille, France
| | - Peter Brown
- 5 Medical Research Council Brain Network Dynamics Unit and Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Alexandre Eusebio
- 2 Institut de Neurosciences de La Timone UMR 7289, Aix Marseille Université, CNRS, 13385, Marseille, France 4 APHM, CHU Timone, Department of Neurology and Movement Disorders, 13385, Marseille, France
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Sauleau P, Drapier S, Duprez J, Houvenaghel JF, Dondaine T, Haegelen C, Drapier D, Jannin P, Robert G, Le Jeune F, Vérin M. Weight Gain following Pallidal Deep Brain Stimulation: A PET Study. PLoS One 2016; 11:e0153438. [PMID: 27070317 PMCID: PMC4829218 DOI: 10.1371/journal.pone.0153438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/29/2016] [Indexed: 12/18/2022] Open
Abstract
The mechanisms behind weight gain following deep brain stimulation (DBS) surgery seem to be multifactorial and suspected depending on the target, either the subthalamic nucleus (STN) or the globus pallidus internus (GPi). Decreased energy expenditure following motor improvement and behavioral and/or metabolic changes are possible explanations. Focusing on GPi target, our objective was to analyze correlations between changes in brain metabolism (measured with PET) and weight gain following GPi-DBS in patients with Parkinson's disease (PD). Body mass index was calculated and brain activity prospectively measured using 2-deoxy-2[18F]fluoro-D-glucose PET four months before and four months after the start of GPi-DBS in 19 PD patients. Dopaminergic medication was included in the analysis to control for its possible influence on brain metabolism. Body mass index increased significantly by 0.66 ± 1.3 kg/m2 (p = 0.040). There were correlations between weight gain and changes in brain metabolism in premotor areas, including the left and right superior gyri (Brodmann area, BA 6), left superior gyrus (BA 8), the dorsolateral prefrontal cortex (right middle gyrus, BAs 9 and 46), and the left and right somatosensory association cortices (BA 7). However, we found no correlation between weight gain and metabolic changes in limbic and associative areas. Additionally, there was a trend toward a correlation between reduced dyskinesia and weight gain (r = 0.428, p = 0.067). These findings suggest that, unlike STN-DBS, motor improvement is the major contributing factor for weight gain following GPi-DBS PD, confirming the motor selectivity of this target.
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Affiliation(s)
- Paul Sauleau
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Neurophysiology, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France
- * E-mail:
| | - Sophie Drapier
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Neurology, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France
| | - Joan Duprez
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
| | - Jean-François Houvenaghel
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Neurology, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France
| | - Thibaut Dondaine
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
| | - Claire Haegelen
- Department of Neurosurgery, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France
- “MediCIS” laboratory (UMR 1099 LTSI), INSERM, University of Rennes 1, Avenue Léon Bernard, Rennes, France
| | - Dominique Drapier
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Psychiatry, Rennes University Hospital, avenue du Général Leclerc, Rennes, France
| | - Pierre Jannin
- Department of Neurosurgery, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France
| | - Gabriel Robert
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Psychiatry, Rennes University Hospital, avenue du Général Leclerc, Rennes, France
| | - Florence Le Jeune
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Oncology, Eugene Marquis Center, Avenue de la Bataille Flandres-Dunkerque, Rennes, France
| | - Marc Vérin
- “Behavior and Basal Ganglia” research unit (EA 4712), University of Rennes 1, Avenue Léon Bernard, Rennes, France
- Department of Neurology, Rennes University Hospital, rue Henri Le Guilloux, Rennes, France
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Lamberti VM, Pereira B, Lhommée E, Bichon A, Schmitt E, Pelissier P, Kistner A, Fraix V, Castrioto A, Esselink RAJ, Durif F, Krack P. Profile of Neuropsychiatric Symptoms in Parkinson’s Disease: Surgical Candidates Compared to Controls. JOURNAL OF PARKINSONS DISEASE 2016; 6:133-42. [DOI: 10.3233/jpd-150698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Valérie M.J. Lamberti
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, F-38000 Grenoble, France
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bruno Pereira
- CHU Clermont-Ferrand, DRCI, Biostatistics Unit, Clermont-Ferrand, France
| | - Eugénie Lhommée
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, F-38000 Grenoble, France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France
- Inserm, U1216, F-38000 Grenoble, France
| | - Amélie Bichon
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, F-38000 Grenoble, France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France
- Inserm, U1216, F-38000 Grenoble, France
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, F-38000 Grenoble, France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France
- Inserm, U1216, F-38000 Grenoble, France
| | - Pierre Pelissier
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, F-38000 Grenoble, France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France
- Inserm, U1216, F-38000 Grenoble, France
| | - Andrea Kistner
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, F-38000 Grenoble, France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France
- Inserm, U1216, F-38000 Grenoble, France
| | - Valérie Fraix
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, F-38000 Grenoble, France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France
- Inserm, U1216, F-38000 Grenoble, France
| | - Anna Castrioto
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, F-38000 Grenoble, France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France
- Inserm, U1216, F-38000 Grenoble, France
| | - Rianne A. J. Esselink
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank Durif
- CHU Clermont-Ferrand, Neurology Department; CHU Gabriel Montpied, and Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
| | - Paul Krack
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, F-38000 Grenoble, France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, F-38000 Grenoble, France
- Inserm, U1216, F-38000 Grenoble, France
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129
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Jumping the Gun: Mapping Neural Correlates of Waiting Impulsivity and Relevance Across Alcohol Misuse. Biol Psychiatry 2016; 79:499-507. [PMID: 26185010 PMCID: PMC4764648 DOI: 10.1016/j.biopsych.2015.06.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/27/2015] [Accepted: 06/01/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Why do we jump the gun or speak out of turn? Waiting impulsivity has a preclinical basis as a predictor for the development of addiction. Here, we mapped the intrinsic neural correlates of waiting and dissociated it from stopping, both fundamental mechanisms of behavioral control. METHODS We used a recently developed translational task to assess premature responding and assess response inhibition using the stop signal task. We mapped the neural correlates in 55 healthy volunteers using a novel multi-echo resting-state functional magnetic resonance imaging sequence and analysis, which robustly boosts signal-to-noise ratio. We further assessed 32 young binge drinkers and 36 abstinent subjects with alcohol use disorders. RESULTS Connectivity of limbic and motor cortical and striatal nodes mapped onto a mesial-lateral axis of the subthalamic nucleus. Waiting impulsivity was associated with lower connectivity of the subthalamic nucleus with ventral striatum and subgenual cingulate, regions similarly implicated in rodent lesion studies. This network was dissociable from fast reactive stopping involving hyperdirect connections of the pre-supplementary area and subthalamic nucleus. We further showed that binge drinkers, like those with alcohol use disorders, had elevated premature responding and emphasized the relevance of this subthalamic network across alcohol misuse. Using machine learning techniques we showed that subthalamic connectivity differentiates binge drinkers and individuals with alcohol use disorders from healthy volunteers. CONCLUSIONS We highlight the translational and clinical relevance of dissociable functional systems of cortical, striatal, and hyperdirect connections with the subthalamic nucleus in modulating waiting and stopping and their importance across dimensions of alcohol misuse.
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130
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Ramirez-Zamora A, Gee L, Boyd J, Biller J. Treatment of impulse control disorders in Parkinson’s disease: Practical considerations and future directions. Expert Rev Neurother 2016; 16:389-99. [DOI: 10.1586/14737175.2016.1158103] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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131
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Martinez-Fernandez R, Pelissier P, Quesada JL, Klinger H, Lhommée E, Schmitt E, Fraix V, Chabardes S, Mertens P, Castrioto A, Kistner A, Broussolle E, Pollak P, Thobois S, Krack P. Postoperative apathy can neutralise benefits in quality of life after subthalamic stimulation for Parkinson's disease. J Neurol Neurosurg Psychiatry 2016; 87:311-8. [PMID: 25934016 DOI: 10.1136/jnnp-2014-310189] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/17/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) improves motor symptoms of Parkinson's disease, leading to improvement in health-related quality of life (HRQoL). However, an excessive decrease in dopaminergic medication can lead to a withdrawal syndrome with apathy as the predominant feature. The present study aims to assess the impact of postoperative apathy on HRQoL. METHODS A cohort of 88 patients who underwent STN-DBS was divided into two groups, those who were apathetic at 1 year and those who were not, as measured by the Starkstein scale. HRQoL was assessed using the Parkinson's disease questionnaire 39 (PDQ-39) and was compared between the two groups. We also compared activities of daily living, motor improvement and motor complications (Unified Parkinson's Disease Rating Scale, UPDRS), depression and anxiety, as well as cognition and drug dosages. Baseline characteristics and postoperative complications were recorded. RESULTS One year after surgery, 27.1% of patients suffered from apathy. While motor improvement was significant and equivalent in both the apathy (-40.4% of UPDRS motor score) and non-apathy groups (-48.6%), the PDQ-39 score did not improve in the apathy group (-5.5%; p=0.464), whereas it improved significantly (-36.7%; p≤0.001) in the non-apathy group. Change in apathy scores correlated significantly with change in HRQoL scores (r=0.278, p=0.009). Depression and anxiety scores remained unchanged from baseline in the apathy group (p=0.409, p=0.075), while they improved significantly in patients without apathy (p=0.006, p≤0.001). A significant correlation was found between changes in apathy and depression (r=0.594, p≤0.001). CONCLUSIONS The development of apathy after STN-DBS can cancel out the benefits of motor improvement in terms of HRQoL. Systematic evaluation and management of apathy occurring after subthalamic stimulation appears mandatory.
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Affiliation(s)
- Raul Martinez-Fernandez
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France CINAC-HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain
| | - Pierre Pelissier
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
| | - Jean-Louis Quesada
- Centre d'Investigation Clinique, CHU de Grenoble, Univesité Joseph Fourier, Grenoble, France Direction de la recherche clinique, Département scientifique, CHU Grenoble, 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
| | - Eugénie Lhommée
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
| | - Valerie Fraix
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
| | - Stephan Chabardes
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France Deparment of Neurosurgery, CHU de Grenoble, 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 and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
| | - Andrea Kistner
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, 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
| | - Pierre Pollak
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France Service de Neurologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - 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 and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
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Magnard R, Vachez Y, Carcenac C, Krack P, David O, Savasta M, Boulet S, Carnicella S. What can rodent models tell us about apathy and associated neuropsychiatric symptoms in Parkinson's disease? Transl Psychiatry 2016; 6:e753. [PMID: 26954980 PMCID: PMC4872443 DOI: 10.1038/tp.2016.17] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 12/19/2022] Open
Abstract
In addition to classical motor symptoms, Parkinson's disease (PD) patients display incapacitating neuropsychiatric manifestations, such as apathy, anhedonia, depression and anxiety. These hitherto generally neglected non-motor symptoms, have gained increasing interest in medical and scientific communities over the last decade because of the extent of their negative impact on PD patients' quality of life. Although recent clinical and functional imaging studies have provided useful information, the pathophysiology of apathy and associated affective impairments remains elusive. Our aim in this review is to summarize and discuss recent advances in the development of rodent models of PD-related neuropsychiatric symptoms using neurotoxin lesion-based approaches. The data collected suggest that bilateral and partial lesions of the nigrostriatal system aimed at inducing reliable neuropsychiatric-like deficits while avoiding severe motor impairments that may interfere with behavioral evaluation, is a more selective and efficient strategy than medial forebrain bundle lesions. Moreover, of all the different classes of pharmacological agents, D2/D3 receptor agonists such as pramipexole appear to be the most efficient treatment for the wide range of behavioral deficits induced by dopaminergic lesions. Lesion-based rodent models, therefore, appear to be relevant tools for studying the pathophysiology of the non-motor symptoms of PD. Data accumulated so far confirm the causative role of dopaminergic depletion, especially in the nigrostriatal system, in the development of behavioral impairments related to apathy, depression and anxiety. They also put forward D2/D3 receptors as potential targets for the treatment of such neuropsychiatric symptoms in PD.
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Affiliation(s)
- R Magnard
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - Y Vachez
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - C Carcenac
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - P Krack
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France,Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Grenoble, France
| | - O David
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - M Savasta
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - S Boulet
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France
| | - S Carnicella
- Inserm U1216, Grenoble, France,Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble, France,Inserm U1216, Grenoble Institute of Neuroscience, Site Santé La Tronche - BP 170, 38042 Grenoble, France. E-mail:
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Subthalamic nucleus deep brain stimulation induces impulsive action when patients with Parkinson's disease act under speed pressure. Exp Brain Res 2016; 234:1837-1848. [PMID: 26892884 PMCID: PMC4893074 DOI: 10.1007/s00221-016-4577-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/28/2016] [Indexed: 12/19/2022]
Abstract
The subthalamic nucleus (STN) is proposed to modulate response thresholds and speed–accuracy trade-offs. In situations of conflict, the STN is considered to raise response thresholds, allowing time for the accumulation of information to occur before a response is selected. Conversely, speed pressure is thought to reduce the activity of the STN and lower response thresholds, resulting in fast, errorful responses. In Parkinson’s disease (PD), subthalamic nucleus deep brain stimulation (STN-DBS) reduces the activity of the nucleus and improves motor symptoms. We predicted that the combined effects of STN stimulation and speed pressure would lower STN activity and lead to fast, errorful responses, hence resulting in impulsive action. We used the motion discrimination ‘moving-dots’ task to assess speed–accuracy trade-offs, under both speed and accuracy instructions. We assessed 12 patients with PD and bilateral STN-DBS and 12 age-matched healthy controls. Participants completed the task twice, and the patients completed it once with STN-DBS on and once with STN-DBS off, with order counterbalanced. We found that STN stimulation was associated with significantly faster reaction times but more errors under speed instructions. Application of the drift diffusion model showed that stimulation resulted in lower response thresholds when acting under speed pressure. These findings support the involvement of the STN in the modulation of speed–accuracy trade-offs and establish for the first time that speed pressure alone, even in the absence of conflict, can result in STN stimulation inducing impulsive action in PD.
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Houeto JL, Magnard R, Dalley JW, Belin D, Carnicella S. Trait Impulsivity and Anhedonia: Two Gateways for the Development of Impulse Control Disorders in Parkinson's Disease? Front Psychiatry 2016; 7:91. [PMID: 27303314 PMCID: PMC4884740 DOI: 10.3389/fpsyt.2016.00091] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/17/2016] [Indexed: 12/03/2022] Open
Abstract
Apathy and impulsivity are two major comorbid syndromes of Parkinson's disease (PD) that may represent two extremes of a behavioral spectrum modulated by dopamine-dependent processes. PD is characterized by a progressive loss of dopaminergic neurons in the substantia nigra pars compacta to which are attributed the cardinal motor symptoms of the disorder. Dopamine replacement therapy (DRT), used widely to treat these motor symptoms, is often associated with deficits in hedonic processing and motivation, including apathy and depression, as well as impulse control disorders (ICDs). ICDs comprise pathological gambling, hypersexuality, compulsive shopping, binge eating, compulsive overuse of dopaminergic medication, and punding. More frequently observed in males with early onset PD, ICDs are associated not only with comorbid affective symptoms, such as depression and anxiety, but also with behavioral traits, such as novelty seeking and impulsivity, as well as with personal or familial history of alcohol use. This constellation of associated risk factors highlights the importance of inter-individual differences in the vulnerability to develop comorbid psychiatric disorders in PD patients. Additionally, withdrawal from DRT in patients with ICDs frequently unmasks a severe apathetic state, suggesting that apathy and ICDs may be caused by overlapping neurobiological mechanisms within the cortico-striato-thalamo-cortical networks. We suggest that altered hedonic and impulse control processes represent distinct prodromal substrates for the development of these psychiatric symptoms, the etiopathogenic mechanisms of which remain unknown. Specifically, we argue that deficits in hedonic and motivational states and impulse control are mediated by overlapping, yet dissociable, neural mechanisms that differentially interact with DRT to promote the emergence of ICDs in vulnerable individuals. Thus, we provide a novel heuristic framework for basic and clinical research to better define and treat comorbid ICDs in PD.
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Affiliation(s)
- Jean-Luc Houeto
- Service de Neurologie, CIC-INSERM 1402, CHU de Poitiers, Université de Poitiers , Poitiers , France
| | - Robin Magnard
- INSERM U1216, Grenoble Institut des Neurosciences (GIN), University Grenoble Alpes , Grenoble , France
| | - Jeffrey W Dalley
- Department of Psychology, University of Cambridge, Cambridge, UK; Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David Belin
- Department of Pharmacology, University of Cambridge , Cambridge , UK
| | - Sebastien Carnicella
- INSERM U1216, Grenoble Institut des Neurosciences (GIN), University Grenoble Alpes , Grenoble , France
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135
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Moro E, Schüpbach M, Wächter T, Allert N, Eleopra R, Honey CR, Rueda M, Schiess MC, Shimo Y, Valkovic P, Whone A, Stoevelaar H. Referring Parkinson's disease patients for deep brain stimulation: a RAND/UCLA appropriateness study. J Neurol 2015; 263:112-9. [PMID: 26530503 PMCID: PMC4723622 DOI: 10.1007/s00415-015-7942-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/04/2015] [Accepted: 10/13/2015] [Indexed: 02/03/2023]
Abstract
In 2005, a European expert panel developed and validated an electronic tool to support the appropriate referral of patients with Parkinson’s disease (PD) for the consideration of deep brain stimulation (DBS). Since new evidence has become available over the last decade an update of the tool is necessary. A world-wide expert panel (71 neurologists and 11 neurosurgeons) used the RAND/UCLA Appropriateness Method to assess the appropriateness of referral for 1296 scenarios (9-point scale). Scenarios were permutations of 8 clinical variables relevant to the decision of referral. Appropriateness of referral was calculated on the basis of the median score and the extent of agreement. Compared to 2005, the impact of clinical variables on the appropriateness of referral was similar for severity of on–off fluctuations, dyskinesias and refractory tremor (positive association, p < 0.001), and cognitive impairment (negative association, p < 0.001). A relatively stronger negative impact was seen for levodopa-unresponsive gait and balance disturbances as well as older age, the latter most likely due to a higher cut-off value (75 versus 70 years in the previous study). The impact of PD duration on the appropriateness of referral was less pronounced than in 2005. The contribution of the newly included variable ‘non-motor side effects of anti-PD medication’ was very modest. Based on these results the panel produced new recommendations on the appropriateness of referral for the evaluation of DBS in PD patients. Differences from the previous study reflect the new clinical evidence, particularly related to the use of DBS in an earlier stage of PD. The validation of the updated recommendations is in progress.
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Affiliation(s)
- Elena Moro
- Division of Neurology, CHU of Grenoble, Joseph Fourier University, INSERM U836, Grenoble, France
| | - Michael Schüpbach
- Department of Neurology, Movement Disorders Center, Bern University Hospital and University of Bern, Bern, Switzerland
- Assistance-Publique Hôpitaux de Paris; Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière; Département de Neurologie, Université Pierre et Marie Curie, Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France
| | - Tobias Wächter
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Center of Rehabilitation, Bad Gögging, Germany
| | - Niels Allert
- Neurological Rehabilitation Center Godeshoehe, Bonn, Germany
| | - Roberto Eleopra
- Department of Neurology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | | | - Mauricio Rueda
- Departamento de Neurociencias, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
| | - Mya C Schiess
- Department of Neurology, University of Texas Medical School at Houston, Texas, USA
| | - Yasushi Shimo
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Peter Valkovic
- 2nd Department of Neurology, Comenius University Faculty of Medicine and University Hospital Bratislava, Bratislava, Slovakia
| | - Alan Whone
- Department of Neurology, Frenchay Hospital, Bristol, UK
| | - Herman Stoevelaar
- Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium.
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Odin P, Ray Chaudhuri K, Slevin J, Volkmann J, Dietrichs E, Martinez-Martin P, Krauss J, Henriksen T, Katzenschlager R, Antonini A, Rascol O, Poewe W. Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson's disease: Consensus from an international survey and discussion program. Parkinsonism Relat Disord 2015; 21:1133-44. [DOI: 10.1016/j.parkreldis.2015.07.020] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 05/20/2015] [Accepted: 07/22/2015] [Indexed: 12/21/2022]
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Speech prosody, reward, and the corticobulbar system: an integrative perspective. Behav Brain Sci 2015; 37:573-4; discussion 577-604. [PMID: 25514963 DOI: 10.1017/s0140525x13004214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Speech prosody is essential for verbal communication. In this commentary I provide an integrative overview, arguing that speech prosody is subserved by the same anatomical and neurochemical mechanisms involved in the processing of reward/affective outcomes.
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138
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Djamshidian A, O'Sullivan SS, Tomassini A, Foltynie T, Limousin P, Aviles-Olmos I, Warner TT, Lees AJ, Averbeck BB. In a rush to decide: deep brain stimulation and dopamine agonist therapy in Parkinson's disease. JOURNAL OF PARKINSONS DISEASE 2015; 4:579-83. [PMID: 25061059 DOI: 10.3233/jpd-140388] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND It has been suggested that all patients with Parkinson's disease (PD) who undergo functional neurosurgery have difficulties in slowing down in high conflict tasks. However, it is unclear whether concomitant dopaminergic medication is responsible for this impairment. OBJECTIVE To assess perceptual decision making in PD patients with bilateral deep brain stimulation. METHODS We tested 27 PD patients with bilateral deep brain stimulation on a task in which participants had to filter task relevant information from background noise. Thirteen patients were treated with Levodopa monotherapy and 14 patients were treated with Levodopa in combination with a dopamine agonist. RESULTS were compared to healthy matched controls. RESULTS We found that all PD patients who were treated with a dopamine agonist made faster decisions than controls and PD patients who were not exposed to a dopamine agonist. Further, all patients made more errors than controls, but there was no difference between the two patient groups. CONCLUSIONS Our results suggest that dopamine agonist therapy rather than deep brain stimulation is likely responsible for the inability to slow down in high conflict situations in PD. These results further strengthen the need to reduce dopamine agonists in PD patients undergoing functional neurosurgery in order to prevent them making inadvisable decisions.
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Affiliation(s)
- Atbin Djamshidian
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, UK Department of Neurology, University Clinic Innsbruck, Tyrol, Austria
| | | | - Alessandro Tomassini
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, UK
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, UK
| | - Iciar Aviles-Olmos
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, UK
| | - Thomas T Warner
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, UK
| | - Andrew J Lees
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, UK
| | - Bruno B Averbeck
- Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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139
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Lindahl AJ, MacMahon DG. The agony of the agonists: a review of impulsivity and withdrawal syndromes in Parkinson's disease treatment. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.15.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The introduction of dopamine agonists was a welcome development in the treatment of Parkinson's disease. However, their history has been somewhat checkered with concerns about their side effects including sudden onset of sleep and ‘sleep attacks’ the development of fibrotic side effects with ergot-derived agents; and most recently, the emergence of impulse control disorders. Furthermore, those who develop these behaviors are those most likely to suffer distressing side effects on their withdrawal: the so-called ‘dopamine agonist withdrawal syndrome’ (DAWS). This review examines this complex area and some suggested strategies to avoid and manage these phenomena, and concludes with some discussion of the future agenda for improving the understanding and management of these conditions.
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Affiliation(s)
- Andrea J Lindahl
- University Hospitals Coventry & Warwickshire NHS Trust, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK
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140
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Abstract
Since its successful application for the treatment of neurological disorders, deep brain stimulation (DBS) is currently also applied for the treatment of psychiatric disorders such as obsessive compulsive disorders or depression. DBS is being considered, or even applied, as a treatment for certain forms of addiction. We review here the cerebral structures aimed for such a strategy and discuss their respective positive and negative aspects.
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Affiliation(s)
- Yann Pelloux
- Équipe BAGAMORE (ganglions de la base, motivation et récompense), institut de neurosciences de la Timone, UMR7289 CNRS et Aix-Marseille université, campus santé Timone, 27, boulevard Jean Moulin, 13385 Marseille cedex 05, France
| | - Christelle Baunez
- Équipe BAGAMORE (ganglions de la base, motivation et récompense), institut de neurosciences de la Timone, UMR7289 CNRS et Aix-Marseille université, campus santé Timone, 27, boulevard Jean Moulin, 13385 Marseille cedex 05, France
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141
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Ethical safety of deep brain stimulation: A study on moral decision-making in Parkinson's disease. Parkinsonism Relat Disord 2015; 21:709-16. [DOI: 10.1016/j.parkreldis.2015.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 03/03/2015] [Accepted: 04/13/2015] [Indexed: 01/10/2023]
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142
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Self-Reported Executive Functioning in Everyday Life in Parkinson's Disease after Three Months of Subthalamic Deep Brain Stimulation. PARKINSONS DISEASE 2015; 2015:461453. [PMID: 26167329 PMCID: PMC4488583 DOI: 10.1155/2015/461453] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/02/2015] [Accepted: 06/09/2015] [Indexed: 01/23/2023]
Abstract
Objective. Studies on the effect of subthalamic deep brain stimulation (STN-DBS) on executive functioning in Parkinson's disease (PD) are still controversial. In this study we compared self-reported daily executive functioning in PD patients before and after three months of STN-DBS. We also examined whether executive functioning in everyday life was associated with motor symptoms, apathy, and psychiatric symptoms. Method. 40 PD patients were examined with the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A), the Symptom Checklist 90-Revised (SCL-90-R), and the Apathy Evaluation Scale (AES-S). Results. PD patients reported significant improvement in daily life executive functioning after 3 months of STN-DBS. Anxiety scores significantly declined, while other psychiatric symptoms remained unchanged. The improvement of self-reported executive functioning did not correlate with motor improvement after STN-DBS. Apathy scores remained unchanged after surgery. Only preoperative depressed mood had predictive value to the improvement of executive function and appears to prevent potentially favorable outcomes from STN-DBS on some aspects of executive function. Conclusion. PD patients being screened for STN-DBS surgery should be evaluated with regard to self-reported executive functioning. Depressive symptoms in presurgical PD patients should be treated. Complementary information about daily life executive functioning in PD patients might enhance further treatment planning of STN-DBS.
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143
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Gee L, Smith H, De La Cruz P, Campbell J, Fama C, Haller J, Ramirez-Zamora A, Durphy J, Hanspal E, Molho E, Barba A, Shin D, Pilitsis JG. The Influence of Bilateral Subthalamic Nucleus Deep Brain Stimulation on Impulsivity and Prepulse Inhibition in Parkinson's Disease Patients. Stereotact Funct Neurosurg 2015; 93:265-70. [PMID: 26066569 DOI: 10.1159/000381558] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/10/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND At least 14% of Parkinson disease (PD) patients develop impulse control disorders (ICDs). The pathophysiology behind these behaviors and the impact of deep brain stimulation in a real-life setting remain unclear. OBJECTIVES We prospectively examined the impact of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on ICDs in PD patients, as well as the relationship between impaired sensorimotor gaiting and impulsivity. METHODS Patients undergoing bilateral STN-DBS were assessed for ICDs preoperatively and 1-year postoperatively using a validated questionnaire (QUIP-RS). A subset of patients completed the Balloon Analogue Risk Task (BART) and auditory prepulse inhibition (PPI) testing. RESULTS Analysis revealed 12 patients had an improvement in score assessing ICDs ('good responders'; p = 0.006) while 4 had a worse or stable score ('poor responders'; p > 0.05). Good responders further exemplified a significant decrease in hypersexual behavior (p = 0.005) and binge eating (p = 0.01). Impaired PPI responses also significantly correlated with impulsivity in BART (r = -0.72, p = 0.044). DISCUSSION Following bilateral STN-DBS, 75% of our cohort had a reduction in ICDs, thus suggesting deep brain stimulation effectively manages ICDs in PD. The role of impaired PPI in predisposition to ICDs in PD warrants further investigation.
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Affiliation(s)
- Lucy Gee
- Department of Neurosurgery, Albany Medical College, Albany, N.Y., USA
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144
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Kim HJ, Jeon BS, Paek SH. Nonmotor Symptoms and Subthalamic Deep Brain Stimulation in Parkinson's Disease. J Mov Disord 2015; 8:83-91. [PMID: 26090080 PMCID: PMC4460544 DOI: 10.14802/jmd.15010] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/18/2015] [Accepted: 04/20/2015] [Indexed: 12/24/2022] Open
Abstract
Subthalamic deep brain stimulation (STN DBS) is an established treatment for the motor symptoms in patients with advanced Parkinson’s disease (PD). In addition to improvements in motor symptoms, many studies have reported changes in various nonmotor symptoms (NMSs) after STN DBS in patients with PD. Psychiatric symptoms, including depression, apathy, anxiety, and impulsivity, can worsen or improve depending on the electrical stimulation parameters, the locations of the stimulating contacts within the STN, and changes in medications after surgery. Global cognitive function is not affected by STN DBS, and there is no increase in the incidence of dementia after STN DBS compared to that after medical treatment, although clinically insignificant declines in verbal fluency have been consistently reported. Pain, especially PD-related pain, improves with STN DBS. Evidence regarding the effects of STN DBS on autonomic symptoms and sleep-related problems is limited and remains conflicting. Many symptoms of nonmotor fluctuations, which are occasionally more troublesome than motor fluctuations, improve with STN DBS. Although it is clear that NMSs are not target symptoms for STN DBS, NMSs have a strong influence on the quality of life of patients with PD, and clinicians should thus be aware of these NMSs when deciding whether to perform surgery and should pay attention to changes in these symptoms after STN DBS to ensure the optimal care for patients.
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Affiliation(s)
- Han-Joon Kim
- Department of Neurology, Movement Disorder Center, Neuroscience Research Institute, College of Medicine, Seoul National University, Seoul, Korea
| | - Beom S Jeon
- Department of Neurology, Movement Disorder Center, Neuroscience Research Institute, College of Medicine, Seoul National University, Seoul, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Movement Disorder Center, Neuroscience Research Institute, College of Medicine, Seoul National University, Seoul, Korea
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145
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The impact of Parkinson's disease and subthalamic deep brain stimulation on reward processing. Neuropsychologia 2015; 75:11-9. [PMID: 25976111 DOI: 10.1016/j.neuropsychologia.2015.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/20/2015] [Accepted: 05/09/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Due to its position in cortico-subthalamic and cortico-striatal pathways, the subthalamic nucleus (STN) is considered to play a crucial role not only in motor, but also in cognitive and motivational functions. In the present study we aimed to characterize how different aspects of reward processing are affected by disease and deep brain stimulation of the STN (DBS-STN) in patients with idiopathic Parkinson's disease (PD). METHODS We compared 33 PD patients treated with DBS-STN under best medical treatment (DBS-on, medication-on) to 33 PD patients without DBS, but optimized pharmacological treatment and 34 age-matched healthy controls. We then investigated DBS-STN effects using a postoperative stimulation-on/ -off design. The task set included a delay discounting task, a task to assess changes in incentive salience attribution, and the Iowa Gambling Task. RESULTS The presence of PD was associated with increased incentive salience attribution and devaluation of delayed rewards. Acute DBS-STN increased risky choices in the Iowa Gambling Task under DBS-on condition, but did not further affect incentive salience attribution or the evaluation of delayed rewards. CONCLUSION Findings indicate that acute DBS-STN affects specific aspects of reward processing, including the weighting of gains and losses, while larger-scale effects of disease or medication are predominant in others reward-related functions.
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146
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Amami P, Dekker I, Piacentini S, Ferré F, Romito LM, Franzini A, Foncke EMJ, Albanese A. Impulse control behaviours in patients with Parkinson's disease after subthalamic deep brain stimulation: de novo cases and 3-year follow-up. J Neurol Neurosurg Psychiatry 2015; 86:562-4. [PMID: 25012201 DOI: 10.1136/jnnp-2013-307214] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 06/14/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To document the occurrence of impulse control behaviours (ICBs) in patients with Parkinson's disease after 3 years of continuous deep brain stimulation (DBS) of the subthalamic nucleus (STN). METHODS Detailed neurological and ICB assessments were performed before STN DBS and up to 3 years after implant. RESULTS 13 out of 56 patients (23.2%) had ICBs at baseline; they took higher doses of dopamine agonists (DAA). Three years after implant 11 had fully remitted with a 60.8% reduction of DAA medication; the remaining two, who had a similar medication reduction, had only compulsive eating, having recovered from hypersexuality. Six of the 43 patients without ICBs at baseline (14%) developed transient de novo ICBs after implant; none of them had ICBs at the 3-year observation. CONCLUSIONS ICBs were abolished in patients 3 years after STN DBS and DAA dosages were lowered. New ICBs may occur after implant and are transient in most cases. Compulsive eating may be specifically related to STN stimulation.
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Affiliation(s)
- P Amami
- Neurologia I, Fondazione Istituto Neurologico Carlo Besta, Milano, Italy
| | - I Dekker
- Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands
| | - S Piacentini
- Neurologia I, Fondazione Istituto Neurologico Carlo Besta, Milano, Italy
| | - F Ferré
- Neurologia I, Fondazione Istituto Neurologico Carlo Besta, Milano, Italy
| | - L M Romito
- Neurologia I, Fondazione Istituto Neurologico Carlo Besta, Milano, Italy
| | - A Franzini
- Neurochirurgia III, Fondazione Istituto Neurologico Carlo Besta, Milano, Italy
| | - E M J Foncke
- Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands
| | - A Albanese
- Neurologia I, Fondazione Istituto Neurologico Carlo Besta, Milano, Italy Istituto di Neurologia, Università Cattolica del Sacro Cuore, Milano, Italy
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147
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Pagonabarraga J, Kulisevsky J, Strafella AP, Krack P. Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment. Lancet Neurol 2015; 14:518-31. [PMID: 25895932 DOI: 10.1016/s1474-4422(15)00019-8] [Citation(s) in RCA: 319] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 09/29/2014] [Accepted: 01/06/2015] [Indexed: 02/06/2023]
Abstract
Normal maintenance of human motivation depends on the integrity of subcortical structures that link the prefrontal cortex with the limbic system. Structural and functional disruption of different networks within these circuits alters the maintenance of spontaneous mental activity and the capacity of affected individuals to associate emotions with complex stimuli. The clinical manifestations of these changes include a continuum of abnormalities in goal-oriented behaviours known as apathy. Apathy is highly prevalent in Parkinson's disease (and across many neurodegenerative disorders) and can severely affect the quality of life of both patients and caregivers. Differentiation of apathy from depression, and discrimination of its cognitive, emotional, and auto-activation components could guide an individualised approach to the treatment of symptoms. The opportunity to manipulate dopaminergic treatment in Parkinson's disease allows researchers to study a continuous range of motivational states, from apathy to impulse control disorders. Parkinson's disease can thus be viewed as a model that provides insight into the neural substrates of apathy.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital and Biomedical Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas, Madrid, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital and Biomedical Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas, Madrid, Spain; Universitat Oberta de Catalunya, Barcelona, Spain
| | - Antonio P Strafella
- Morton and Gloria Shulman Movement Disorder Unit, E.J. Safra Parkinson Disease Program, Toronto Western Hospital and Research Institute, UHN, ON, Canada; Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, ON, Canada
| | - Paul Krack
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France; INSERM, Unit 836, Grenoble Institut des Neurosciences, Grenoble, France.
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148
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Rieu I, Martinez-Martin P, Pereira B, De Chazeron I, Verhagen Metman L, Jahanshahi M, Ardouin C, Chéreau I, Brefel-Courbon C, Ory-Magne F, Klinger H, Peyrol F, Schupbach M, Dujardin K, Tison F, Houeto JL, Krack P, Durif F. International validation of a behavioral scale in Parkinson's disease without dementia. Mov Disord 2015; 30:705-13. [PMID: 25809278 DOI: 10.1002/mds.26223] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 12/08/2014] [Accepted: 12/14/2014] [Indexed: 12/16/2022] Open
Abstract
The "Ardouin Scale of Behavior in Parkinson's Disease" is a new instrument specifically designed for assessing mood and behavior with a view to quantifying changes related to Parkinson's disease, to dopaminergic medication, and to non-motor fluctuations. This study was aimed at analyzing the psychometric attributes of this scale in patients with Parkinson's disease without dementia. In addition to this scale, the following measures were applied: the Unified Parkinson's Disease Rating Scale, the Montgomery and Asberg Depression Rating Scale, the Lille Apathy Rating Scale, the Bech and Rafaelsen Mania Scale, the Positive and Negative Syndrome Scale, the MacElroy Criteria, the Patrick Carnes criteria, the Hospital Anxiety and Depression Scale, and the Mini-International Neuropsychiatric Interview. Patients (n=260) were recruited at 13 centers across four countries (France, Spain, United Kingdom, and United States). Cronbach's alpha coefficient for domains ranged from 0.69 to 0.78. Regarding test-retest reliability, the kappa coefficient for items was higher than 0.4. For inter-rater reliability, the kappa values were 0.29 to 0.81. Furthermore, most of the items from the Ardouin Scale of Behavior in Parkinson's Disease correlated with the corresponding items of the other scales, depressed mood with the Montgomery and Asberg Depression Rating Scale (ρ=0.82); anxiety with the Hospital Anxiety and Depression Scale-anxiety (ρ=0.56); apathy with the Lille Apathy Rating Scale (ρ=0.60). The Ardouin Scale of Behavior in Parkinson's disease is an acceptable, reproducible, valid, and precise assessment for evaluating changes in behavior in patients with Parkinson's disease without dementia.
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Affiliation(s)
- Isabelle Rieu
- CHU Clermont-Ferrand, Neurology Department; CHU Gabriel Montpied, Clermont-Ferrand, France; Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
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149
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Tremblay L, Worbe Y, Thobois S, Sgambato-Faure V, Féger J. Selective dysfunction of basal ganglia subterritories: From movement to behavioral disorders. Mov Disord 2015; 30:1155-70. [DOI: 10.1002/mds.26199] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/14/2015] [Accepted: 02/06/2015] [Indexed: 12/14/2022] Open
Affiliation(s)
- Léon Tremblay
- Centre de Neurosciences Cognitives-UMR 5229; CNRS-Université de Lyon 1; Bron France
| | - Yulia Worbe
- UPMC Université Paris 6, UMR-S975, CRICM-Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière; Paris France
| | - Stéphane Thobois
- Centre de Neurosciences Cognitives-UMR 5229; CNRS-Université de Lyon 1; Bron France
- Hospices Civils de Lyon, Hopital Neurologique Pierre Wertheimer, Neurologie C; Lyon France
- Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux; Lyon France
| | | | - Jean Féger
- UPMC Université Paris 6, UMR-S975, CRICM-Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière; Paris France
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150
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Skorvanek M, Gdovinova Z, Rosenberger J, Ghorbani Saeedian R, Nagyova I, Groothoff JW, van Dijk JP. The associations between fatigue, apathy, and depression in Parkinson's disease. Acta Neurol Scand 2015; 131:80-7. [PMID: 25288130 DOI: 10.1111/ane.12282] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Fatigue and apathy are two of the most common and most disabling non-motor symptoms of Parkinson's disease (PD). They have a high coincidence and can often be confused; moreover, their relationship is not fully understood. The aim of our study was to describe the coincidence of apathy with different fatigue domains in the presence/absence of depression and to separately describe the associations of different aspects of primary and secondary fatigue with apathy and other clinical and disease-related factors. MATERIALS AND METHODS A total of 151 non-demented patients with PD were examined using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Starkstein Apathy Scale, Multidimensional Fatigue Inventory (MFI), Beck Depression Inventory-II, and Epworth Sleepiness Scale. RESULTS The prevalence and severity of fatigue and apathy were significantly higher in depressed PD patients. However, our results show that depression, fatigue, and apathy can be clearly distinguished in PD. Apathy was associated with the MFI's-reduced motivation domain in both depressed and non-depressed patients. However, apathy was associated with mental fatigue aspects only in non-depressed patients, and it was not related to the physical aspects of fatigue in any of the studied groups. CONCLUSIONS Although the pathophysiology of fatigue and apathy in PD is clearly multifactorial, in a proportion of PD patients, these symptoms are associated with depression, dopaminergic depletion in the mesocorticolimbic structures, and disruption of the prefrontal cortex-basal ganglia axis. Therefore, in some PD patients, adequate management of depression and optimal dopaminergic medication may improve both fatigue and apathy.
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Affiliation(s)
- M. Skorvanek
- Department of Neurology; Safarik University; Kosice Slovak Republic
- Department of Neurology; L. Pasteur University Hospital; Kosice Slovak Republic
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
| | - Z. Gdovinova
- Department of Neurology; Safarik University; Kosice Slovak Republic
- Department of Neurology; L. Pasteur University Hospital; Kosice Slovak Republic
| | - J. Rosenberger
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
| | - R. Ghorbani Saeedian
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
- Department of Social Medicine; Institute of Public Health; Safarik University; Kosice Slovak Republic
| | - I. Nagyova
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
- Department of Social Medicine; Institute of Public Health; Safarik University; Kosice Slovak Republic
| | - J. W. Groothoff
- Department of Community and Occupational Health; University Medical Center Groningen; Groningen The Netherlands
| | - J. P. van Dijk
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
- Department of Community and Occupational Health; University Medical Center Groningen; Groningen The Netherlands
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