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Witt K, Levin J, van Eimeren T, Hasan A, Ebersbach G. Diagnostics and treatment of impulse control disorders, psychosis and delirium: systemic review-based recommendations - guideline "Parkinson's disease" of the German Society of Neurology. J Neurol 2024:10.1007/s00415-024-12576-x. [PMID: 39046524 DOI: 10.1007/s00415-024-12576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Impulse control disorders (ICD), psychosis and delirium are part of the spectrum of behavioural changes associated with Parkinson's disease (PD). The diagnostic and therapeutic management of these rather complex neuropsychiatric conditions has been updated in the clinical guideline by the German Society of Neurology (DGN). METHODS Recommendations are based on a systematic literature reviews, other relevant guidelines and expert opinion. RESULTS Patients receiving dopamine agonists (DA) therapy should be informed about the symptoms and risks of an ICD and should be routinely screened for ICD symptoms. In the presence of an ICD, DA should be reduced or discontinued and psychotherapeutic treatment may be considered. Non-oral therapies (levodopa/carbidopa intestinal gel infusion or deep brain stimulation) may also be an option for appropriate candidates. Psychosis in PD often has a gradual onset. Cognitive and affective disorders, psychiatric and medical comorbidities as well as polypharmacy are risk factors for a psychosis. Non-pharmacological treatments should be implemented as soon as possible and anti-parkinsonian medications should be adjusted/reduced if feasible. For psychosis associated with PD, quetiapine or clozapine should be used on an as-needed basis and for as short a time as is necessary, with safety monitoring. Delirium in PD may be underdiagnosed due to an overlap with chronic neuropsychiatric features of PD. Although transient by definition, delirium in PD can lead to permanent cognitive decline, motor impairment and increased mortality. Management of delirium includes pharmacological and non-pharmacological interventions. CONCLUSION The updated guideline encompasses the evidence-based diagnostic, non-pharmacological and pharmacological management of ICD, psychosis and delirium in PD.
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Affiliation(s)
- Karsten Witt
- Department of Neurology, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Marienstrasse 15, 26121, Oldenburg, Germany.
- University Clinic of Neurology, Evangelical Hospital, Oldenburg, Germany.
- Center of Neurosensory Sciences, University of Oldenburg, Oldenburg, Germany.
| | - Johannes Levin
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases, Site Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | | | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- DZPG (German Center for Mental Health), Partner Site München/Augsburg, Augsburg, Germany
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Meyer M, Spitz E, Colnat-Coulbois S, Benatru I, Guehl D, Hainque E, Rolland AS, Corvol JC, Devilliers H, Schwan R, Devos D. Development and validation of the DBS-PS (Deep Brain Stimulation-Perception Scale): Assessing parkinsonian patients' expectations to prevent post-operative disappointment? J Neurol Sci 2024; 462:123093. [PMID: 38908172 DOI: 10.1016/j.jns.2024.123093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/17/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Recent literature suggests that taking into consideration and evaluating preoperative expectations of Parkinson's disease (PD) patients candidates to deep brain stimulation (DBS), can contribute to treatment effectiveness. However, few validated instruments investigating preoperative expectations are available. We present the development and validation of the DBS-PS (Deep Brain Stimulation - Perception Scale). METHODS The DBS-PS is an 11 questions self-administered scale, with answers rated on a 10-point Likert scale (1 completely false, 10 completely true). Items were generated on the basis of patient's interviews analyzed by an expert group and reached consensus. The scale is divided into three domains: expectations for PD, expectations for social-life and leisure, expectations for intimate life. Exploratory factor analysis (EFA) completed by item response theory (IRT) analysis was conducted to validate the theoretical structure of the DBS-PS. RESULTS 64 PD patients aged 59.18 (SD = 5.74) years with PD diagnosed since 9.36 (SD = 4.09) years completed the DBS-PS preoperatively. EFA confirmed a 3 factors scale structure (eigenvalue >1) explaining 69% of variance (factor 1: 43%; factor 2: 17%; factor 3: 9%). Reliability (Cronbach's α: 0.714 for factor 1, 0.781 for factor 2, 0.889 for factor 3) and discriminant validity (Pearson coefficient r < 0.50) were satisfactory. IRT showed good model fit, preserved unidimensionality, but some local dependences were observed. CONCLUSION The DBS-PS shows satisfactory psychometric properties. It is easy to administer in routine practice with preoperative PD patients. It constitutes an interesting basis for cognitive restructuring before neurosurgery, by highlighting dysfunctional cognitions and measuring the benefits of cognitive restructuring therapy.
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Affiliation(s)
- Mylène Meyer
- Service de neurologie, CHRU Nancy, 54000 Nancy, France.
| | - Elisabeth Spitz
- Université de Lorraine, UMR 1319 INSPIIRE, Equipe Psychologie de la Santé de Metz (EPSAM), Metz, France
| | | | - Isabelle Benatru
- Service de Neurologie, Centre Expert Parkinson, CIC-INSERM 1402, CHU Poitiers, NS-PARK/FCRIN Network, 86000 Poitiers, France
| | - Dominique Guehl
- Service d'Explorations Fonctionnelles du Système Nerveux, Institut des Maladies Neurodégénératives Cliniques, CHU de Bordeaux, NS-PARK/FCRIN Network, Bordeaux, France
| | - Elodie Hainque
- Université Sorbonne, Assistance Publique Hôpitaux de Paris, Paris Brain Institute, Inserm, CNRS, Service de neurologie, Centre d'Investigation Clinique neurosciences, NS-PARK/FCRIN Network, Paris, France
| | - Anne-Sophie Rolland
- Université de Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, LICEND, NS-PARK/FCRIN Network, Lille, France
| | - Jean-Christophe Corvol
- Université Sorbonne, Assistance Publique Hôpitaux de Paris, Paris Brain Institute, Inserm, CNRS, Service de neurologie, Centre d'Investigation Clinique neurosciences, NS-PARK/FCRIN Network, Paris, France
| | - Hervé Devilliers
- Centre Hospitalier Universitaire de Dijon, Hôpital François Mitterrand, service de médecine interne et maladies systémiques (médecine interne 2) et Centre d'Investigation Clinique, Inserm CIC-EC 1432, 3 rue du FBG Raines, 21000 Dijon, France
| | - Raymund Schwan
- Centre Psychothérapique de Nancy, 1 rue du Docteur Archambault, BP11010 Laxou Cedex, France; Université de Lorraine, INSERM, CHU Nancy, U1254 - Imagerie Adaptative Diagnostique et Interventionnelle, Nancy, France
| | - David Devos
- Université de Lille, INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, LICEND, NS-PARK/FCRIN Network, Lille, France; CHU Lille, Neurology and Movement Disorders Department, Reference Center for Parkinson's Disease, NS-PARK/FCRIN Network, Lille, France
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Zapf AC, Olgemöller PM, Gollan R, Kalbe E, Folkerts AK. Possible improvement of social adjustment after subthalamic deep brain stimulation in people with Parkinson's disease? A systematic review and meta-analysis. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02787-x. [PMID: 38795178 DOI: 10.1007/s00702-024-02787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/08/2024] [Indexed: 05/27/2024]
Abstract
Interactions with others need social adjustment (i.e., the constant accommodation to changing social situations). Mixed evidence indicates positive as well as negative changes in social adjustment after subthalamic nucleus deep brain stimulation (STN-DBS) in people with Parkinson's Disease (PwPD). To date, however, no meta-analysis of these changes exists. Thus, the study aim was to review evidence of the effects of STN-DBS on social adjustment in PwPD. For this purpose, a systematic literature search in MEDLINE was conducted. The meta-analysis was performed using a random effects model and standardized mean differences (SMDs) with 95% confidence intervals (CIs). The MINORS tool was used to assess the methodological quality of the studies. The initial literature search identified 13,124 articles, of which 1,550 full texts were assessed for eligibility. Eight studies were finally included; for seven articles sufficient data for a meta-analysis was available. Most studies found mild impairment in social adjustment impairment pre-surgery. The meta-analysis revealed no significant changes but a statistical trend towards improvement in social adjustment up to six months (SMD = 0.25; 95%CI=-0.03,0.53; P = 0.08) and over 12 months (SMD = 0.26; 95%CI=-0.03,0.55; P = 0.07) post-surgery. Methodological quality was moderate in 87.5% of the studies and good in 12.5%. While mild impairment in social adjustment pre-surgery was reported in most studies, the data indicate that STN-DBS might yield beneficial effects toward this outcome. However, not enough data yet exists to draw firm conclusions. As a crucial skill for everyday functioning, social adjustment should be more often defined as an outcome in STN-DBS trials in PwPD and should be considered in clinical routines.
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Affiliation(s)
- Alexandra C Zapf
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Paulina M Olgemöller
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Romina Gollan
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition (IPAN), Geelong, Victoria, Australia
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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Bertrand M, Chabardes S, Fontanier V, Procyk E, Bastin J, Piallat B. Contribution of the subthalamic nucleus to motor, cognitive and limbic processes: an electrophysiological and stimulation study in monkeys. Front Neurosci 2024; 18:1257579. [PMID: 38456146 PMCID: PMC10918855 DOI: 10.3389/fnins.2024.1257579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
Deep brain stimulation of the subthalamic nucleus (STN) has become the gold standard surgical treatment for Parkinson's disease and is being investigated for obsessive compulsive disorders. Even if the role of the STN in the behavior is well documented, its organization and especially its division into several functional territories is still debated. A better characterization of these territories and a better knowledge of the impact of stimulation would address this issue. We aimed to find specific electrophysiological markers of motor, cognitive and limbic functions within the STN and to specifically modulate these components. Two healthy non-human primates (Macaca fascicularis) performed a behavioral task allowing the assessment of motor, cognitive and limbic reward-related behavioral components. During the task, four contacts in the STN allowed recordings and stimulations, using low frequency stimulation (LFS) and high frequency stimulation (HFS). Specific electrophysiological functional markers were found in the STN with beta band activity for the motor component of behavior, theta band activity for the cognitive component, and, gamma and theta activity bands for the limbic component. For both monkeys, dorsolateral HFS and LFS of the STN significantly modulated motor performances, whereas only ventromedial HFS modulated cognitive performances. Our results validated the functional overlap of dorsal motor and ventral cognitive subthalamic territories, and, provide information that tends toward a diffuse limbic territory sensitive to the reward within the STN.
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Affiliation(s)
- Mathilde Bertrand
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institute of Neurosciences, Grenoble, France
| | - Stephan Chabardes
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institute of Neurosciences, Grenoble, France
- Univ. Grenoble Alpes, Department of Neurosurgery, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institute Neurosciences, Grenoble, France
- Clinatec-CEA Leti, Grenoble, France
| | - Vincent Fontanier
- Univ. Lyon 1, Inserm, Stem Cell and Brain Research Institute U1208, Bron, France
- Medinetic Learning, Research Department, Paris, France
| | - Emmanuel Procyk
- Univ. Lyon 1, Inserm, Stem Cell and Brain Research Institute U1208, Bron, France
| | - Julien Bastin
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institute of Neurosciences, Grenoble, France
| | - Brigitte Piallat
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institute of Neurosciences, Grenoble, France
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Prasad AA, Wallén-Mackenzie Å. Architecture of the subthalamic nucleus. Commun Biol 2024; 7:78. [PMID: 38200143 PMCID: PMC10782020 DOI: 10.1038/s42003-023-05691-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
The subthalamic nucleus (STN) is a major neuromodulation target for the alleviation of neurological and neuropsychiatric symptoms using deep brain stimulation (DBS). STN-DBS is today applied as treatment in Parkinson´s disease, dystonia, essential tremor, and obsessive-compulsive disorder (OCD). STN-DBS also shows promise as a treatment for refractory Tourette syndrome. However, the internal organization of the STN has remained elusive and challenges researchers and clinicians: How can this small brain structure engage in the multitude of functions that renders it a key hub for therapeutic intervention of a variety of brain disorders ranging from motor to affective to cognitive? Based on recent gene expression studies of the STN, a comprehensive view of the anatomical and cellular organization, including revelations of spatio-molecular heterogeneity, is now possible to outline. In this review, we focus attention to the neurobiological architecture of the STN with specific emphasis on molecular patterns discovered within this complex brain area. Studies from human, non-human primate, and rodent brains now reveal anatomically defined distribution of specific molecular markers. Together their spatial patterns indicate a heterogeneous molecular architecture within the STN. Considering the translational capacity of targeting the STN in severe brain disorders, the addition of molecular profiling of the STN will allow for advancement in precision of clinical STN-based interventions.
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Affiliation(s)
- Asheeta A Prasad
- University of Sydney, School of Medical Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia.
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Wilt JA, Merner AR, Zeigler J, Montpetite M, Kubu CS. Corrigendum: Does personality change follow deep brain stimulation in Parkinson's disease patients? Front Psychol 2023; 14:1235029. [PMID: 37502745 PMCID: PMC10370348 DOI: 10.3389/fpsyg.2023.1235029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyg.2021.643277.].
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Affiliation(s)
- Joshua A. Wilt
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Amanda R. Merner
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Jaclyn Zeigler
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | | | - Cynthia S. Kubu
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
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Zuk P, Sanchez CE, Kostick-Quenet K, Muñoz KA, Kalwani L, Lavingia R, Torgerson L, Sierra-Mercado D, Robinson JO, Pereira S, Outram S, Koenig BA, McGuire AL, Lázaro-Muñoz G. Researcher Views on Changes in Personality, Mood, and Behavior in Next-Generation Deep Brain Stimulation. AJOB Neurosci 2023; 14:287-299. [PMID: 35435795 PMCID: PMC9639000 DOI: 10.1080/21507740.2022.2048724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The literature on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises concerns that these technologies may affect personality, mood, and behavior. We conducted semi-structured interviews with researchers (n = 23) involved in developing next-generation DBS systems, exploring their perspectives on ethics and policy topics including whether DBS/aDBS can cause such changes. The majority of researchers reported being aware of personality, mood, or behavioral (PMB) changes in recipients of DBS/aDBS. Researchers offered varying estimates of the frequency of PMB changes. A smaller majority reported changes in personality specifically. Some expressed reservations about the scientific status of the term 'personality,' while others used it freely. Most researchers discussed negative PMB changes, but a majority said that DBS/aDBS can also result in positive changes. Several researchers viewed positive PMB changes as part of the therapeutic goal in psychiatric applications of DBS/aDBS. Finally, several discussed potential causes of PMB changes other than the device itself.
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Mameli F, Ruggiero F, Dini M, Marceglia S, Prenassi M, Borellini L, Cogiamanian F, Pirola E, Remore LG, Fiore G, Reitano MR, Maiorana N, Poletti B, Locatelli M, Barbieri S, Priori A, Ferrucci R. Energy Delivered by Subthalamic Deep Brain Stimulation for Parkinson Disease Correlates With Depressive Personality Trait Shift. Neuromodulation 2023; 26:394-402. [PMID: 35221204 DOI: 10.1016/j.neurom.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/09/2021] [Accepted: 01/07/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Despite the large amount of literature examining the potential influence of subthalamic nucleus deep brain stimulation (STN-DBS) on psychiatric symptoms and cognitive disorders, only a few studies have focused on its effect on personality. We investigated the correlation between total electrical energy delivered (TEED) and the occurrence of depressive traits in patients with Parkinson disease (PD) after one year of DBS. MATERIALS AND METHODS Our study involved 20 patients with PD (12 women, mean [±SD] age 57.60 ± 7.63 years) who underwent bilateral STN-DBS, whose personality characteristics were assessed using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), according to the core assessment program for surgical interventional therapies in Parkinson's disease (CAPSIT-PD) procedure. RESULTS We found that despite a marked improvement in motor functions and quality of life after 12 months, patients showed a significant increase in MMPI-2 subscales for depression (D scale and Depression scale) and in other content component scales (low self-esteem, work interference, and negative treatment indicators). Interestingly, only the TEED on the right side was inversely correlated with the changes in scale D (rs = -0.681, p = 0.007), whereas depressive traits did not correlate with disease duration, levodopa equivalent daily dose (LEDD) reduction, patient's age, or severity of motor symptoms. CONCLUSIONS Our preliminary observations indicate that despite the excellent motor outcome and general improvement in quality of life, DBS treatment can result in patients poorly adjusting to their personal, familiar, and socio-professional life. Different influences and multiple factors (such as TEED, intra/postsurgical procedure, coping mechanisms, and outcome expectations) may affect depressive traits. Further advances are expected to improve stimulation methods.
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Affiliation(s)
- Francesca Mameli
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Fabiana Ruggiero
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Michelangelo Dini
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Marco Prenassi
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Linda Borellini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Filippo Cogiamanian
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Elena Pirola
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Luigi Gianmaria Remore
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Giorgio Fiore
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Maria Rita Reitano
- Neurology Unit I, San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Natale Maiorana
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Marco Locatelli
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Sergio Barbieri
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy; Neurology Unit I, San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Roberta Ferrucci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy; Neurology Unit I, San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan, Italy.
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Gilbert F, Smith J, Daly A. Is Theory Fading Away from Reality? Examining the Pathology Rather than the Technology to Understand Potential Personality Changes. AJOB Neurosci 2023; 14:45-47. [PMID: 36524947 DOI: 10.1080/21507740.2022.2150712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Bove F, Genovese D, Moro E. Developments in the mechanistic understanding and clinical application of deep brain stimulation for Parkinson's disease. Expert Rev Neurother 2022; 22:789-803. [PMID: 36228575 DOI: 10.1080/14737175.2022.2136030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION. Deep brain stimulation (DBS) is a life-changing treatment for patients with Parkinson's disease (PD) and gives the unique opportunity to directly explore how basal ganglia work. Despite the rapid technological innovation of the last years, the untapped potential of DBS is still high. AREAS COVERED. This review summarizes the developments in the mechanistic understanding of DBS and the potential clinical applications of cutting-edge technological advances. Rather than a univocal local mechanism, DBS exerts its therapeutic effects through several multimodal mechanisms and involving both local and network-wide structures, although crucial questions remain unexplained. Nonetheless, new insights in mechanistic understanding of DBS in PD have provided solid bases for advances in preoperative selection phase, prediction of motor and non-motor outcomes, leads placement and postoperative stimulation programming. EXPERT OPINION. DBS has not only strong evidence of clinical effectiveness in PD treatment, but technological advancements are revamping its role of neuromodulation of brain circuits and key to better understanding PD pathophysiology. In the next few years, the worldwide use of new technologies in clinical practice will provide large data to elucidate their role and to expand their applications for PD patients, providing useful insights to personalize DBS treatment and follow-up.
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Affiliation(s)
- Francesco Bove
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Danilo Genovese
- Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Elena Moro
- Grenoble Alpes University, CHU of Grenoble, Division of Neurology, Grenoble, France.,Grenoble Institute of Neurosciences, INSERM, U1216, Grenoble, France
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Brezovar S, Pažek L, Kavčič M, Georgiev D, Trošt M, Flisar D. Personality Changes After Subthalamic Nucleus Stimulation in Parkinson’s Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1231-1240. [PMID: 35342047 PMCID: PMC9198740 DOI: 10.3233/jpd-212879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: While deep brain stimulation of the subthalamic nucleus (STN-DBS) significantly improves motor deficits in patients with Parkinson’s disease (PD), it is still unclear whether it affects personality functioning. Objective: The objective of the present study was to examine personality changes in patients with PD after STN-DBS from the perspectives of both the patients and caregivers. Moreover, by assessing the premorbid personalities of the patients, we tried to determine individual vulnerability to STN-DBS-induced personality changes. Methods: In total, 27 patients and their caregivers participated in our retrospective observational study. They were asked to assess the patients’ personality changes with the Iowa Scale of Personality Changes (ISPC) and the patients’ premorbid personalities with the Big Five Inventory (BFI). Results: Caregivers reported significant personality changes in the ISPC domains of Executive Disturbance (p = 0.01) and Disturbed Social Behavior (p = 0.02). Most of the ISPC domains were positively correlated with Conscientiousness, while Executive Disturbance was negatively correlated with Neuroticism of the BFI scale. Conclusion: Our results show that executive and social functioning are the two most vulnerable domains in patients with PD after STN-DBS, especially in those patients who score higher for neuroticism and lower for conscientiousness on the BFI scale. The results of our study may provide movement disorder specialists with better counseling options and better selection of DBS candidates. Caregivers’ perspective might contribute significantly in understanding postoperative personality changes.
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Affiliation(s)
- Simon Brezovar
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia
| | - Lucija Pažek
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Martin Kavčič
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dejan Georgiev
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Computer and Information Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Trošt
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Dušan Flisar
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Gasmi A, Noor S, Piscopo S, Menzel A. Toxic Metal -Mediated Neurodegradation: A Focus on Glutathione and GST Gene Variants. ARCHIVES OF RAZI INSTITUTE 2022; 77:525-536. [PMID: 36284949 PMCID: PMC9548276 DOI: 10.22092/ari.2021.356279.1816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/09/2021] [Indexed: 05/26/2023]
Abstract
Increasing pieces of evidence have supported those chemicals from industrial, agricultural wastes and organoleptic activities play important role in the development of neurological disorders. The frequency of neurological disorders is increased to a much extent in recent years with the advancements in science and technology. Google Scholar, PubMed, and Scopus databases were selected to search the relevant information by using keywords including "Heavy metals", "Neurotoxicity", "Glutathione", "Glutathione AND Neurodegenerative disorders" etc. Heavy metals are particularly recognized as a major resource of toxicities during the stage of early pregnancy where a fetus gets exposed to them from maternal activities and circulation. As infants have a weak immune system and cannot respond to the specific challenge as faced by the body during mercury, zinc, iron, and cadmium exposure. Daily diet and drinking habits in addition to industrial activities also form a major field of study under investigation. This study aims to investigate the role of these metals in the accumulation of pollutants in the brain, liver, and kidneys hence leading to serious consequences. Moreover, their prevalence in teenagers that are under the age of ten years is being observed that leads them to learn, writing, and intellectual abilities. Males are more affected due to their hormonal differences. The role of the GST gene in the development of cognitive conditions and its phenotypes has been discussed thoroughly in this review. The mutations of GST lead to the accumulation of peroxides and superoxides which exacerbate oxidative damage to cells. Binding of toxic metals to GSH genes and the role of glutathione transferase genes is was demonstrated in this review.
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Affiliation(s)
- A Gasmi
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
| | - S Noor
- Institute of Molecular Biology and Biotechnology, Bahauddin Zakariya University Multan, Pakistan
| | - S Piscopo
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
- Research and Development Department, Nutri-Logics SA, Weiswampach, Luxembourg
| | - A Menzel
- Laboratoires Réunis, Junglinster, Luxembourg
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13
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Sarni N. Nouvelles influences pour la nosographie psychiatrique. ANNALES MEDICO-PSYCHOLOGIQUES 2022. [DOI: 10.1016/j.amp.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Favier M, Carcenac C, Savasta M, Carnicella S. Dopamine D3 Receptors: A Potential Target to Treat Motivational Deficits in Parkinson's Disease. Curr Top Behav Neurosci 2022; 60:109-132. [PMID: 35469394 DOI: 10.1007/7854_2022_316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Parkinson's disease (PD), which is traditionally viewed as a motor disorder involving the degeneration of dopaminergic (DA) neurons, has recently been identified as a quintessential neuropsychiatric condition. Indeed, a plethora of non-motor symptoms may occur in PD, including apathy. Apathy can be defined as a lack of motivation or a deficit of goal-directed behaviors and results in a pathological decrease of self-initiated voluntary behavior. Apathy in PD appears to fluctuate with the DA state of the patients, suggesting a critical role of DA neurotransmission in the pathophysiology of this neuropsychiatric syndrome. Using a lesion-based approach, we developed a rodent model which exhibits specific alteration in the preparatory component of motivational processes, reminiscent to apathy in PD. We found a selective decrease of DA D3 receptors (D3R) expression in the dorsal striatum of lesioned rats. Next, we showed that inhibition of D3R neurotransmission in non-lesioned animals was sufficient to reproduce the motivational deficit observed in our model. Interestingly, we also found that pharmacologically targeting D3R efficiently reversed the motivational deficit induced by the lesion. Our findings, among other recent data, suggest a critical role of D3R in parkinsonian apathy and highlight this receptor as a promising target for treating motivational deficits.
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Affiliation(s)
- Mathieu Favier
- Douglas Mental Health University Institute, McGill University, Verdun, QC, Canada
| | - Carole Carcenac
- Inserm, U1216, Univ. Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Marc Savasta
- Inserm, Délégation régionale Provence-Alpes-Côte d'Azur et Corse, Marseille CEDEX 09, France
| | - Sebastien Carnicella
- Inserm, U1216, Univ. Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.
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15
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Onofrj M, Di Iorio A, Carrarini C, Russo M, Franciotti R, Espay AJ, Boylan LS, Taylor JP, Di Giannantonio M, Martinotti G, Valente EM, Thomas A, Bonanni L, Delli Pizzi S, Dono F, Sensi S. Preexisting Bipolar Disorder Influences the Subsequent Phenotype of Parkinson's Disease. Mov Disord 2021; 36:2840-2852. [PMID: 34427338 PMCID: PMC9292484 DOI: 10.1002/mds.28745] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 12/13/2022] Open
Abstract
Background Patients with bipolar spectrum disorders (BSDs) exhibit an increased risk of Parkinson's disease (PD). Objective The aim is to investigate whether a previous diagnosis of BSDs influences the phenotype of PD. Methods Of 2660 PD patients followed for at least 6 years (6–27), 250 (BSD‐PD) had BSDs, 6–20 years before PD diagnosis; 48%–43% had a PD or BSD family history, and 34 carried glucocerebrosidase (GBA) and Parkin (PRKN) mutations. The cohort was split into a subset of 213 BSD‐PD patients, compared with 426 matched PD patients without BSDs, and a subset of 34 BSD‐PD and 79 PD patients carrying GBA or PRKN mutations. Carriers of mutations absent in BSD‐PD patients and of synuclein triplication were excluded. Structured clinical interviews and mood disorder questionnaires assessed BSDs. Linear mixed models evaluated the assessment scales over time. Thirteen BSD‐PD patients underwent subthalamic nucleus deep brain stimulation (STN‐DBS) and were compared with 27 matched STN‐DBS‐treated PD patients. Results Compared to PD patients, BSD‐PD showed (1) higher frequency of family history of PD (odds ratio [OR] 3.31; 2.32–4.71) and BSDs (OR 6.20; 4.11–9.35) 5); (2) higher incidence of impulse control disorders (hazard ratio [HR] 5.95, 3.89–9.09); (3) higher frequency of functional disorders occurring before PD therapy (HR, 5.67, 3.95–8.15); (4) earlier occurrence of delusions or mild dementia (HR, 7.70, 5.55–10.69; HR, 1.43, 1.16–1.75); and (5) earlier mortality (1.48; 1.11–1.97). Genetic BSD‐PD subjects exhibited clinical features indistinguishable from nongenetic BSD‐PD subjects. STN‐DBS‐treated BSD‐PD patients showed no improvements in quality of life compared to the control group. Conclusions BSDs as a prodrome to PD unfavorably shape their course and are associated with detrimental neuropsychiatric features and treatment outcomes. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Center of Advanced Studies and Technology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,YDA Foundation, Institute of Immune Therapy and Advanced Biological Treatments, Pescara, Italy
| | - Angelo Di Iorio
- Department of Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Raffaella Franciotti
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Alberto J Espay
- Department of Neurology, James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura S Boylan
- Department of Neurology, Bellevue Hospital, New York University School of Medicine, New York, New York, USA
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Enza M Valente
- IRCCS Mondino Foundation and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Astrid Thomas
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano Delli Pizzi
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - StefanoL Sensi
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Center of Advanced Studies and Technology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Institute for Mind Impairments and Neurological Disorders (IMIND), University of California-Irvine, Irvine, California, USA
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16
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Wilt JA, Merner AR, Zeigler J, Montpetite M, Kubu CS. Does Personality Change Follow Deep Brain Stimulation in Parkinson's Disease Patients? Front Psychol 2021; 12:643277. [PMID: 34393883 PMCID: PMC8361492 DOI: 10.3389/fpsyg.2021.643277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Deep Brain Stimulation (DBS) has emerged as a safe, effective, and appealing treatment for Parkinson's Disease (PD), particularly for improving motor symptoms (e. g., tremor, bradykinesia, and rigidity). However, concerns have been raised about whether DBS causes psychological changes, including changes to personality: characteristic and relatively stable patterns of affect, behavior, cognition, and desire. In this article, after first presenting some background information about PD and DBS, we examined evidence obtained from various empirical research methods (quantitative, qualitative, and mixed methods for evaluating patient valued characteristics) pertaining to whether DBS causes personality change. General limitations across research methods include a lack of randomized clinical trials and small sample sizes. We organized our review of findings according to different layers of personality variables: dispositional traits (including personality pathology), characteristic adaptations, and narrative identity. Though most work has been done on dispositional traits, there is not much evidence that dispositional traits change following DBS. Little work has been done on characteristic adaptations, but there is somewhat consistent evidence for positive perceived progress toward goals across a number of domains: routine activities, work, social/relational, and leisure. Nascent work on narrative identity holds promise for revealing issues around self-image that may be common following DBS. We listed a number of strategies for advancing research, highlighting opportunities related to personality conceptualization, personality assessment, and interdisciplinary scholarship. Finally, we offer practical applications of our findings for the informed consent process and for ongoing treatment.
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Affiliation(s)
- Joshua A Wilt
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Amanda R Merner
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States.,Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Jaclyn Zeigler
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | | | - Cynthia S Kubu
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
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17
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Passamonti C, Mancini F, Cesaroni E, Bonifazi S, Ceravolo MG, Capecci M, Zamponi N, Scerrati M, Ricciuti RA. Deep brain stimulation in patients with long history of drug resistant epilepsy and poor functional status: Outcomes based on the different targets. Clin Neurol Neurosurg 2021; 208:106827. [PMID: 34329812 DOI: 10.1016/j.clineuro.2021.106827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/13/2021] [Accepted: 07/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a widely used surgical procedure for the treatment of patients with drug resistant epilepsy (DRE) and several anatomical target have been described. Indications for DBS includes patients with focal, partial seizure and those for which resective or disconnective surgery are contraindicated, such as involvement of eloquent cortex or significant comorbidities. Despite the SANTE trial has clearly indicated the efficacy of DBS of anterior nucleus of the thalamus (ANT), specific indications regarding the best anatomical target and outcome in patients with severe disability are lacking. Here we described our case series of patients underwent DBS of three different target including ANT, centromedian thalamic nucleus (CMN) and subthalamic nucleus (STN). METHOD Six patients with DRE have been treated with DBS of ANT (n = 3), STN (n = 2) and CMN (n = 1). Outcome has been expressed as seizures frequency reduction and patients functional status after surgery with a follow-up of 5-11 years. RESULTS Four out of six patients show no reduction of seizures frequency after DBS implant with one case of increasing atypical absence. Two cases, one ANT and one CMN, show a significant reduction of seizures frequency of 50-60%. No patients improve relative to functional outcome and one showed psychiatric symptoms worsening. CONCLUSIONS For patients with DRE and severe functional disability, DBS may reduce seizure frequency in some cases, but it does not improve functional outcome.
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Affiliation(s)
- C Passamonti
- Unit of Hospital Psychology, Ospedali Riuniti, Ancona, Italy
| | - F Mancini
- Clinic of Neurosurgery, Ospedali Riuniti, Ancona, Italy.
| | - E Cesaroni
- Child and adolescent psychiatry, Ospedale Salesi, Ancona, Italy
| | - S Bonifazi
- Clinic of Neurosurgery, Ospedali Riuniti, Ancona, Italy
| | - M G Ceravolo
- Department of Experimental and Clinical Medicine, "Università Politecnica delle Marche", Ancona, Italy
| | - M Capecci
- Department of Experimental and Clinical Medicine, "Università Politecnica delle Marche", Ancona, Italy
| | - N Zamponi
- Child and adolescent psychiatry, Ospedale Salesi, Ancona, Italy
| | - M Scerrati
- Clinic of Neurosurgery, Ospedali Riuniti, Ancona, Italy
| | - R A Ricciuti
- Unit of Neurosurgery, Ospedale Belcolle, Viterbo, Italy
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18
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Zirbes C, Jones A, Manzel K, Denburg N, Barrash J. Assessing the Effects of Healthy and Neuropathological Aging on Personality with the Iowa Scales of Personality Change. Dev Neuropsychol 2021; 46:393-408. [PMID: 34283684 DOI: 10.1080/87565641.2021.1956500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Personality changes in older adults with brain disease may be confounded by effects of normal aging. In this cross-sectional study, ratings with the Iowa Scales of Personality Change for 62 healthy older adults (OA-H, aged 60+) were compared to matched older adults with brain diseases (OA-BD). OA-H did not show any significant personality changes from middle age to older adulthood. However, between 10% and 20% of OA-H developed a disturbance in Lack of Stamina, Inflexibility, Lability, and Lack of Insight. Otherwise, the pattern of findings suggesting normal aging effects on personality disturbances in clinical groups are generally minimal.
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Affiliation(s)
- Christian Zirbes
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, United States
| | - Andrew Jones
- Department of Computer Science, Princeton University, Princeton, United States
| | - Kenneth Manzel
- Department of Neurology, University of Iowa, Iowa City, United States
| | - Natalie Denburg
- Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, United States
| | - Joseph Barrash
- Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, United States
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19
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Kucuker MU, Almorsy AG, Sonmez AI, Ligezka AN, Doruk Camsari D, Lewis CP, Croarkin PE. A Systematic Review of Neuromodulation Treatment Effects on Suicidality. Front Hum Neurosci 2021; 15:660926. [PMID: 34248523 PMCID: PMC8267816 DOI: 10.3389/fnhum.2021.660926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Neuromodulation is an important group of therapeutic modalities for neuropsychiatric disorders. Prior studies have focused on efficacy and adverse events associated with neuromodulation. Less is known regarding the influence of neuromodulation treatments on suicidality. This systematic review sought to examine the effects of various neuromodulation techniques on suicidality. Methods: A systematic review of the literature from 1940 to 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was conducted. Any reported suicide-related outcome, including suicidal ideation, suicide intent, suicide attempt, completed suicide in reports were considered as a putative measure of treatment effect on suicidality. Results: The review identified 129 relevant studies. An exploratory analysis of a randomized controlled trial comparing the effects of sertraline and transcranial direct-current stimulation (tDCS) for treating depression reported a decrease in suicidal ideation favoring tDCS vs. placebo and tDCS combined with sertraline vs. placebo. Several studies reported an association between repetitive transcranial magnetic stimulation and improvements in suicidal ideation. In 12 of the studies, suicidality was the primary outcome, ten of which showed a significant improvement in suicidal ideation. Electroconvulsive therapy (ECT) and magnetic seizure therapy was also shown to be associated with lower suicidal ideation and completed suicide rates. There were 11 studies which suicidality was the primary outcome and seven of these showed an improvement in suicidal ideation or suicide intent and fewer suicide attempts or completed suicides in patients treated with ECT. There was limited literature focused on the potential protective effect of vagal nerve stimulation with respect to suicidal ideation. Data were mixed regarding the potential effects of deep brain stimulation on suicidality. Conclusions: Future prospective studies of neuromodulation that focus on the primary outcome of suicidality are urgently needed. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=125599, identifier: CRD42019125599.
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Affiliation(s)
- Mehmet Utku Kucuker
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ammar G. Almorsy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ayse Irem Sonmez
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Anna N. Ligezka
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, United States
| | - Deniz Doruk Camsari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Charles P. Lewis
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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20
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Costanza A, Radomska M, Bondolfi G, Zenga F, Amerio A, Aguglia A, Serafini G, Amore M, Berardelli I, Pompili M, Nguyen KD. Suicidality Associated With Deep Brain Stimulation in Extrapyramidal Diseases: A Critical Review and Hypotheses on Neuroanatomical and Neuroimmune Mechanisms. Front Integr Neurosci 2021; 15:632249. [PMID: 33897384 PMCID: PMC8060445 DOI: 10.3389/fnint.2021.632249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Deep brain stimulation (DBS) is a very well-established and effective treatment for patients with extrapyramidal diseases. Despite its generally favorable clinical efficacy, some undesirable outcomes associated with DBS have been reported. Among such complications are incidences of suicidal ideation (SI) and behavior (SB) in patients undergoing this neurosurgical procedure. However, causal associations between DBS and increased suicide risk are not demonstrated and they constitute a debated issue. In light of these observations, the main objective of this work is to provide a comprehensive and unbiased overview of the literature on suicide risk in patients who received subthalamic nucleus (STN) and internal part of globus pallidum (GPi) DBS treatment. Additionally, putative mechanisms that might be involved in the development of SI and SB in these patients as well as caveats associated with these hypotheses are introduced. Finally, we briefly propose some clinical implications, including therapeutic strategies addressing these potential disease mechanisms. While a mechanistic connection between DBS and suicidality remains a controversial topic that requires further investigation, it is of critical importance to consider suicide risk as an integral component of candidate selection and post-operative care in DBS.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Michalina Radomska
- Faculty of Psychology, University of Geneva (UNIGE), Geneva, Switzerland
| | - Guido Bondolfi
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention (SPLIC), Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Francesco Zenga
- Department of Neurosurgery, University and City of Health and Science Hospital, Turin, Italy
| | - Andrea Amerio
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Mood Disorders Program, Tufts Medical Center, Boston, MA, United States
| | - Andrea Aguglia
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Khoa D Nguyen
- Department of Microbiology and Immunology, Stanford University, Palo Alto, CA, United States.,Tranquis Therapeutics, Palo Alto, CA, United States.,Hong Kong University of Science and Technology, Hong Kong, China
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21
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Sasikumar S, Matta R, Munhoz RP, Zurowski M, Poon YY, Hodaie M, Kalia SK, Lozano AM, Fasano A. Advanced Therapies for the Management of Dopamine Dysregulation Syndrome in Parkinson's Disease. Mov Disord Clin Pract 2021; 8:400-405. [PMID: 33816669 DOI: 10.1002/mdc3.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/23/2020] [Accepted: 01/07/2021] [Indexed: 11/11/2022] Open
Abstract
Background Dopamine Dysregulation Syndrome (DDS) is an adverse non-motor complication of dopamine replacement therapy in Parkinson's disease. The current literature on this syndrome is limited, and it remains underdiagnosed and challenging to manage. Objective To assess the role of advanced therapies in the management of DDS. Methods We performed a retrospective chart review and identified patients who fit the inclusion criteria for DDS. They were classified according to risk factors that have been identified in the literature, motor and complication scores, intervention (medical or surgical) and outcome. Multivariate analyses were performed to analyze these characteristics. Results Twenty-seven patients were identified (23 males, mean age of onset: 49 ± 8.8 years). Average levodopa equivalent daily dose was 1916.7 ± 804 mg and a history of impulse control disorders, psychiatric illness, and substance abuse was present in 89%, 70% and 3.7% of the patients, respectively. Overall 81.5% of patients had symptom resolution at follow up, on average 4.8 ± 3.5 years after management, with medication only (7/9), levodopa-carbidopa intestinal gel (1/3), deep brain stimulation of subthalamic nucleus (10/13), or globus pallidus pars interna (2/2). Reduction of medications occurred with deep brain stimulation of subthalamic nucleus (P = 0.01) but was associated with a relapse in two patients. Conclusion Although the small sample size of some subgroups limits our ability to draw meaningful conclusions, our results did not suggest superiority of a single treatment option. Advanced therapies including deep brain stimulation can be considered in patients with DDS refractory to conservative measures, but outcome is variable and relapse is possible.
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Affiliation(s)
| | | | - Renato P Munhoz
- Division of Neurology University of Toronto Toronto Ontario Canada.,Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre Toronto Western Hospital, UHN Toronto Ontario Canada.,Krembil Brain Institute Toronto Ontario Canada
| | - Mateusz Zurowski
- Toronto Western Hospital, Department of Psychiatry University of Toronto Toronto Ontario Canada
| | - Yu-Yan Poon
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre Toronto Western Hospital, UHN Toronto Ontario Canada
| | - Mojgan Hodaie
- Krembil Brain Institute Toronto Ontario Canada.,Toronto Western Hospital, Division of Neurosurgery University of Toronto Toronto Ontario Canada
| | - Suneil K Kalia
- Krembil Brain Institute Toronto Ontario Canada.,Toronto Western Hospital, Division of Neurosurgery University of Toronto Toronto Ontario Canada
| | - Andres M Lozano
- Krembil Brain Institute Toronto Ontario Canada.,Toronto Western Hospital, Division of Neurosurgery University of Toronto Toronto Ontario Canada
| | - Alfonso Fasano
- Division of Neurology University of Toronto Toronto Ontario Canada.,Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre Toronto Western Hospital, UHN Toronto Ontario Canada.,Krembil Brain Institute Toronto Ontario Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA) Toronto Ontario Canada
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22
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Does the Personality of Patients with Parkinson's Disease Affect the Decision to Perform Deep Brain Stimulation Surgery? A Cross-Sectional Study in a Chinese Cohort. Behav Neurol 2021; 2021:6639255. [PMID: 33574965 PMCID: PMC7857895 DOI: 10.1155/2021/6639255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/14/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022] Open
Abstract
We investigated whether the personality of patients with Parkinson's disease (PD) before subthalamic brain stimulation differed from patients receiving drug treatments and whether the personality of patients affected surgical decisions. We recruited 38 patients with advanced PD scheduled for deep brain stimulation (DBS), 40 patients with PD receiving the very best medical treatment, and 51 healthy control subjects. All participants were evaluated by the Minnesota multiphasic personality inventory-1 (MMPI-1). PD patients who were candidates for DBS did not exhibit any significant differences in personality when compared with PD patients who were treated with drugs. Compared with healthy controls, patients with PD had remarkably higher MMPI-1 scores for spiritual quality, neuroticism, and introversion, but significantly lower scores for socialization. In addition, patients with PD were more submissive, more dependent on others, and less active in social activities. Our data indicated that the main deciding factor relating to whether to undergo DBS was the disease itself and not the pathological personality. However, neurotic and psychotic symptoms accompanying PD may influence the effect of DBS. We found that greater benefit is obtained by surgical or medical interventions if abnormal neurotic characteristics are considered early in the course of PD.
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Meyer M, Colnat-Coulbois S, Frismand S, Vidailhet P, Llorca PM, Spitz E, Schwan R. Parkinson's Disease and Bilateral Subthalamic Nuclei Deep Brain Stimulation: Beneficial Effects of Preoperative Cognitive Restructuration Therapy on Postoperative Social Adjustment. World Neurosurg 2020; 145:282-289. [PMID: 33007440 DOI: 10.1016/j.wneu.2020.09.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bilateral subthalamic nucleus deep brain stimulation improves motor symptoms and treatment-related complications in patients with Parkinson's disease. However, some patients have trouble adjusting socially after successful neurosurgery, in part because of "unrealistic" expectations and psychiatric disorders. Preoperative psychological interventions focusing on these aspects could be beneficial for such patients. METHODS We compared the outcomes of 2 psychosocial approaches-1 based on cognitive restructuration and 1 consisting of 2 interviews-with those of a control group without preoperative preparation. All patients underwent a psychometric evaluation 2 months before surgery (M-2) and again at 3 (M+3) and 6 months (M+6) after surgery. The psychometric evaluation focused on social adjustment using the social adjustment scale-self-report. The psychiatric profile of the patients was also assessed. RESULTS Of 73 patients initially enrolled, 62 performed the initial inclusion visit (M-2) and the 2 postoperative visits (M+3, M+6). For these 62 patients (52% male), the overall mean age was 59 ± 6.13 years, and the mean disease duration was 9.44 ± 3.62 years. No specific differences were observed for social adjustment between the groups or visits (M-2, M+3, M+6); however, an interaction was found in the cognitive restructuration group at M+6 for the family dimension of the social adjustment scale-self-report. CONCLUSION Our results suggest that even if no overall increase in the social adjustment score was observed, patients with Parkinson's disease eligible for neurosurgery should undergo preoperative psychosocial therapy to define their expectations and help them in their psychological restructuration. This type of therapy, complementary to psychoeducation, could represent an opportunity to prevent postoperative deception and social maladjustment.
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Affiliation(s)
- Mylène Meyer
- Service de Neurologie, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France.
| | - Sophie Colnat-Coulbois
- Département de Neurochirurgie, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France; Faculté de médecine, Université de Lorraine, Nancy, France
| | - Solène Frismand
- Service de Neurologie, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | | | | | - Elisabeth Spitz
- Laboratoire de Psychologie de la Santé de Metz-EPSAM, EA 4360 APEMAC, UFR Sciences Humaines et Sociales, Ile du Saulcy, Université de Lorraine, Metz, France
| | - Raymund Schwan
- Faculté de médecine, Université de Lorraine, Nancy, France; Centre Psychothérapique de Nancy, Laxou, France
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Berardelli I, Belvisi D, Nardella A, Falcone G, Lamis DA, Fabbrini G, Berardelli A, Girardi P, Pompili M. Suicide in Parkinson's Disease: A Systematic Review. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2020; 18:466-477. [PMID: 31269887 DOI: 10.2174/1871527318666190703093345] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 06/01/2019] [Accepted: 06/18/2019] [Indexed: 12/13/2022]
Abstract
Psychiatric disorders and suicide have been reported in patients suffering from Parkinson's disease. The aims of the present paper were to determine whether patients with Parkinson's disease have an increased rate of suicide and to identify the clinical features possibly associated with suicide risk in Parkinson's disease. We also reviewed the studies on suicide risk in Parkinson's disease in patients after deep brain stimulation. We performed a Medline, Excerpta Medica, PsycLit, PsycInfo and Index Medicus search to identify all articles published on this topic from 1970 to 2019. The following search terms were used: suicide OR suicide attempt OR suicidal ideation OR suicide risk AND Parkinson's disease AND Parkinson's disease and deep brain stimulation. The studies we identified that assessed the suicide rate associated with Parkinson's disease yielded contrasting results, although an increase in suicidal ideation did emerge. The studies on the effect of deep brain stimulation on suicide risk in Parkinson's disease also reported mixed findings. Psychiatric symptoms, including depression, appear to be associated with suicide risk in patients with Parkinson's disease undergoing medical and after surgical treatment. The studies reviewed suggest that suicidal ideation is increased in Parkinson's disease. Further longitudinal studies designed to assess suicidality in this condition are still needed.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Adele Nardella
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giulia Falcone
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Dorian A Lamis
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30303, United States
| | - Giovanni Fabbrini
- IRCSS Neuromed Institute Pozzilli, IS, Italy.,Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Alfredo Berardelli
- IRCSS Neuromed Institute Pozzilli, IS, Italy.,Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Hescham S, Liu H, Jahanshahi A, Temel Y. Deep brain stimulation and cognition: Translational aspects. Neurobiol Learn Mem 2020; 174:107283. [PMID: 32739395 DOI: 10.1016/j.nlm.2020.107283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/10/2020] [Accepted: 07/26/2020] [Indexed: 11/19/2022]
Abstract
Many neurological patients suffer from memory loss. To date, pharmacological treatments for memory disorders have limited and short-lasting effects. Therefore, researchers are investigating novel therapies such as deep brain stimulation (DBS) to alleviate memory impairments. Up to now stimulation of the fornix, nucleus basalis of Meynert and entorhinal cortex have been found to enhance memory performance. Here, we provide an overview of the different DBS targets and mechanisms within the memory circuit, which could be relevant for enhancing memory in patients. Future studies are warranted, accelerating the efforts to further unravel mechanisms of action of DBS in memory-related disorders and develop stimulation protocols based on these mechanisms.
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Affiliation(s)
- Sarah Hescham
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands; European Graduate School of Neuroscience (EURON), Maastricht University, Maastricht, the Netherlands.
| | - Huajie Liu
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands; European Graduate School of Neuroscience (EURON), Maastricht University, Maastricht, the Netherlands
| | - Ali Jahanshahi
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands; European Graduate School of Neuroscience (EURON), Maastricht University, Maastricht, the Netherlands
| | - Yasin Temel
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands; European Graduate School of Neuroscience (EURON), Maastricht University, Maastricht, the Netherlands
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Effects of Subthalamic Nucleus Deep Brain Stimulation on Facial Emotion Recognition in Parkinson's Disease: A Critical Literature Review. Behav Neurol 2020; 2020:4329297. [PMID: 32724481 PMCID: PMC7382738 DOI: 10.1155/2020/4329297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/12/2020] [Indexed: 01/04/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective therapy for Parkinson's disease (PD). Nevertheless, DBS has been associated with certain nonmotor, neuropsychiatric effects such as worsening of emotion recognition from facial expressions. In order to investigate facial emotion recognition (FER) after STN DBS, we conducted a literature search of the electronic databases MEDLINE and Web of science. In this review, we analyze studies assessing FER after STN DBS in PD patients and summarize the current knowledge of the effects of STN DBS on FER. The majority of studies, which had clinical and methodological heterogeneity, showed that FER is worsening after STN DBS in PD patients, particularly for negative emotions (sadness, fear, anger, and tendency for disgust). FER worsening after STN DBS can be attributed to the functional role of the STN in limbic circuits and the interference of STN stimulation with neural networks involved in FER, including the connections of the STN with the limbic part of the basal ganglia and pre- and frontal areas. These outcomes improve our understanding of the role of the STN in the integration of motor, cognitive, and emotional aspects of behaviour in the growing field of affective neuroscience. Further studies using standardized neuropsychological measures of FER assessment and including larger cohorts are needed, in order to draw definite conclusions about the effect of STN DBS on emotional recognition and its impact on patients' quality of life.
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Suicide and suicide attempts after subthalamic nucleus stimulation in Parkinson's disease: a systematic review and meta-analysis. Neurol Sci 2020; 42:267-274. [PMID: 32643134 DOI: 10.1007/s10072-020-04555-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Deep-brain stimulation is a well-established, effective treatment for patients with advanced Parkinson's disease. Recent studies examining rates of suicide attempts and suicides after deep-brain stimulation in the bilateral subthalamic nucleus have reported varying results. Using this systematic review and meta-analysis, we aim to obtain a comprehensive understanding of suicidality in Parkinson's patients after subthalamic nucleus deep brain stimulation. METHODS We systematically examined Medline, PubMed, Web of Science, and Embase databases to identify studies published before November 2019 that measured rates of suicidality in Parkinson's patients who underwent subthalamic nucleus stimulation. A meta-analysis of the data from the included studies was conducted using Stata 12.0. RESULTS A total of 18 studies met the eligibility criteria of this study. We found that the pooled rate of suicidal ideation was 4% (95% CI 0.00-7.2%, range 2-17%). The pooled rate of suicide attempts was 1% (95% CI 1.0-2.0%), while the pooled rate of suicide was 1% (95% CI 0.0-1.0%). CONCLUSIONS Our findings indicate a relatively high rate of suicidality among Parkinson's patients after subthalamic nucleus deep-brain stimulation. It is important for clinicians to carefully monitor psychiatric disorders, especially suicidal ideation and suicide attempts, in Parkinson's patients before and after subthalamic nucleus deep-brain stimulation.
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Pugh J. Clarifying the Normative Significance of 'Personality Changes' Following Deep Brain Stimulation. SCIENCE AND ENGINEERING ETHICS 2020; 26:1655-1680. [PMID: 32189235 PMCID: PMC7286862 DOI: 10.1007/s11948-020-00207-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/29/2020] [Indexed: 05/11/2023]
Abstract
There is evidence to suggest that some patients who undergo Deep Brain Stimulation can experience changes to dispositional, emotional and behavioural states that play a central role in conceptions of personality, identity, autonomy, authenticity, agency and/or self (PIAAAS). For example, some patients undergoing DBS for Parkinson's Disease have developed hypersexuality, and some have reported increased apathy. Moreover, experimental psychiatric applications of DBS may intentionally seek to elicit changes to the patient's dispositional, emotional and behavioural states, in so far as dysfunctions in these states may undergird the targeted disorder. Such changes following DBS have been of considerable interest to ethicists, but there is a considerable degree of conflict amongst different parties to this debate about whether DBS really does change PIAAAS, and whether this matters. This paper explores these conflicting views and suggests that we may be able to mediate this conflict by attending more closely to what parties to the debate mean when they invoke the concepts lumped together under the acronym PIAAAS. Drawing on empirical work on patient attitudes, this paper outlines how these different understandings of the concepts incorporated into PIAAAS have been understood in this debate, and how they may relate to other fundamental concepts in medical ethics such as well-being and autonomy. The paper clarifies some key areas of disagreement in this context, and develops proposals for how ethicists might fruitfully contribute to future empirical assessments of apparent changes to PIAAAS following DBS treatment.
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Affiliation(s)
- Jonathan Pugh
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford, OX1 1PT, UK.
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Macerollo A, Zrinzo L, Akram H, Foltynie T, Limousin P. Subthalamic nucleus deep brain stimulation for Parkinson’s disease: current trends and future directions. Expert Rev Med Devices 2020; 17:1063-1074. [DOI: 10.1080/17434440.2020.1747433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Antonella Macerollo
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- School of Psychology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Harith Akram
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Patricia Limousin
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
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Meloni M, Puligheddu M, Carta M, Cannas A, Figorilli M, Defazio G. Efficacy and safety of 5‐hydroxytryptophan on depression and apathy in Parkinson's disease: a preliminary finding. Eur J Neurol 2020; 27:779-786. [DOI: 10.1111/ene.14179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/05/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Affiliation(s)
- M. Meloni
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - M. Puligheddu
- Sleep Disorders Center Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
- Department of Medical Sciences and Public Health, Neurology Unit University of Cagliari and AOU Cagliari Monserrato, Cagliari Italy
| | - M. Carta
- Department of Biomedical Sciences University of Cagliari Cagliari Italy
| | - A. Cannas
- Department of Medical Sciences and Public Health, Neurology Unit University of Cagliari and AOU Cagliari Monserrato, Cagliari Italy
| | - M. Figorilli
- Sleep Disorders Center Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - G. Defazio
- Department of Medical Sciences and Public Health, Neurology Unit University of Cagliari and AOU Cagliari Monserrato, Cagliari Italy
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Gilbert F, Brown, Dasgupta, Martens, Klein, Goering. An Instrument to Capture the Phenomenology of Implantable Brain Device Use. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09422-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Gardenhire J, Mullet N, Fife S. Living With Parkinson's: The Process of Finding Optimism. QUALITATIVE HEALTH RESEARCH 2019; 29:1781-1793. [PMID: 31179832 DOI: 10.1177/1049732319851485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Individuals with Parkinson's disease (PD) often experience poor mental and emotional well-being, which negatively affect their quality of life. Optimism is a protective factor which has been shown to promote resiliency, reduce distress in health crises, and protect against the effects of negative mental health outcomes. The current article utilized grounded theory methodology to examine personal accounts (N = 85) detailing how individuals were able to cultivate optimism despite challenges presented by PD. The grounded theory indicated that a process occurs in which individuals with PD move through the following five phases on their journey toward optimism: (a) diagnosis, (b) initial reactions, (c) adjustment, (d) acceptance, and (e) living with optimism. These findings indicate that individuals with PD often struggle to experience optimism. Nevertheless, by reframing optimism as a choice rather than a feeling, participants were able to make decisions that allowed them to progress on their journey toward optimism.
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Changes in Personality Associated with Deep Brain Stimulation: a Qualitative Evaluation of Clinician Perspectives. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09419-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Accolla EA, Pollo C. Mood Effects After Deep Brain Stimulation for Parkinson's Disease: An Update. Front Neurol 2019; 10:617. [PMID: 31258509 PMCID: PMC6587122 DOI: 10.3389/fneur.2019.00617] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/28/2019] [Indexed: 11/23/2022] Open
Abstract
Depression in Parkinson's Disease (PD) is a prevalent and invalidating symptom. Deep brain stimulation (DBS) allows for an improvement of PD motor features, but its effects on mood are difficult to predict. Here, we review the evidence regarding mood effects after DBS of either subthalamic nucleus (STN) or globus pallidus pars interna (GPi). Different influences of multiple factors contribute to impact the neuropsychiatric outcome after surgery. Psychosocial presurgical situation, postsurgical coping mechanisms, dopaminergic treatment modifications, and direct effects of the stimulation of either target are all playing a distinct role on the psychological well-being of patients undergoing DBS. No clear advantage of either target (STN vs. GPi) has been consistently found, both being effective and with a favorable profile on depression symptoms. However, specific patients' characteristics or anatomical considerations can guide the neurosurgeon in the target choice. Further research together with technological advances are expected to confine the stimulation area within dysfunctional circuits causing motor symptoms of PD.
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Affiliation(s)
- Ettore A. Accolla
- Neurology Unit, Department of Medicine, HFR – Hôpital Cantonal Fribourg and Fribourg University, Fribourg, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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Giannini G, Francois M, Lhommée E, Polosan M, Schmitt E, Fraix V, Castrioto A, Ardouin C, Bichon A, Pollak P, Benabid AL, Seigneuret E, Chabardes S, Wack M, Krack P, Moro E. Suicide and suicide attempts after subthalamic nucleus stimulation in Parkinson disease. Neurology 2019; 93:e97-e105. [PMID: 31101738 DOI: 10.1212/wnl.0000000000007665] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/18/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the postoperative attempted and completed suicide rates after subthalamic nucleus deep brain stimulation (STN-DBS) in a single-center cohort and to determine factors associated with attempted and completed suicide. METHODS We retrospectively included all patients with Parkinson disease (PD) who underwent bilateral STN-DBS surgery at the Grenoble University Hospital between 1993 and 2016. For each patient who committed or attempted suicide, 2 patients with PD with STN-DBS without any suicidal behaviors were matched for age (±1 year), sex, and year of surgery (±2 years). Clinical data were collected from medical records. Detailed preoperative and postoperative neuropsychological evaluations, including frontal and Beck Depression Inventory (BDI) scores, were gathered. RESULTS A total of 534 patients with PD were included. Completed and attempted suicide percentages were 0.75% (4 of 534) and 4.11% (22 of 534), respectively. The observed suicide rate in the first postoperative year (187.20 of 100,000 per year, 1 of 534) was higher than the expected National Observatory on Suicide Risks rate adjusted for age and sex (standardized mortality ratio 8.1). This rate remained similar over the second and third postoperative years. In a comparison of the 26 patients completing/attempting suicide and the 52 controls, the first group showed more frequent history of suicidal ideation/suicide attempts and psychotic symptoms, higher percentage of family psychiatric history, higher psychiatric medication use, and higher preoperative frontal and BDI scores on neuropsychological evaluations. CONCLUSIONS Suicide behaviors can occur after STN-DBS, especially during the first 3 years. A careful multidisciplinary assessment and long-term follow-up are recommended to recognize and treat this potentially preventable risk for mortality.
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Affiliation(s)
- Giulia Giannini
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Matthieu Francois
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Eugénie Lhommée
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Mircea Polosan
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Emmanuelle Schmitt
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Valérie Fraix
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Anna Castrioto
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Claire Ardouin
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Amélie Bichon
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Pierre Pollak
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Alim-Louis Benabid
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Eric Seigneuret
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Stephan Chabardes
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Maxime Wack
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Paul Krack
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France
| | - Elena Moro
- From the IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G.), UOC Clinica Neurologica; Department of Biomedical and NeuroMotor Sciences (G.G.), Alma Mater Studiorum, University of Bologna, Italy; Movement Disorders Unit (G.G., E.L., E.S., V.F., A.C., C.A., A.B., P.P., P.K., E.M.), Division of Neurology and Clinique de Psychiatrie (M.F., M.P.), Pôle Neurologie Psychiatrie, CHU of Grenoble, Grenoble Alpes University; Department of Neurosurgery (A.-L.B., E.S., S.C.), CHU of Grenoble, Grenoble Alpes University; and Department of Medical Informatics (M.W.), HEGP, AP-HP, Paris, France.
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Mosley PE, Robinson K, Coyne T, Silburn P, Breakspear M, Carter A. ‘Woe Betides Anybody Who Tries to Turn me Down.’ A Qualitative Analysis of Neuropsychiatric Symptoms Following Subthalamic Deep Brain Stimulation for Parkinson’s Disease. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09410-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Lhommée E, Wojtecki L, Czernecki V, Witt K, Maier F, Tonder L, Timmermann L, Hälbig TD, Pineau F, Durif F, Witjas T, Pinsker M, Mehdorn M, Sixel-Döring F, Kupsch A, Krüger R, Elben S, Chabardès S, Thobois S, Brefel-Courbon C, Ory-Magne F, Regis JM, Maltête D, Sauvaget A, Rau J, Schnitzler A, Schüpbach M, Schade-Brittinger C, Deuschl G, Houeto JL, Krack P. Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson's disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial. Lancet Neurol 2019; 17:223-231. [PMID: 29452685 DOI: 10.1016/s1474-4422(18)30035-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving combined treatment with subthalamic stimulation and medical therapy over a 2-year follow-up period as compared with the behavioural evolution under medical therapy alone. METHODS We did a parallel, open-label study (EARLYSTIM) at 17 surgical centres in France (n=8) and Germany (n=9). We recruited patients with Parkinson's disease who were disabled by early motor complications. Participants were randomly allocated (1:1) to either medical therapy alone or bilateral subthalamic stimulation plus medical therapy. The primary outcome was mean change in quality of life from baseline to 2 years. A secondary analysis was also done to assess behavioural outcomes. We used the Ardouin Scale of Behavior in Parkinson's Disease to assess changes in behaviour between baseline and 2-year follow-up. Apathy was also measured using the Starkstein Apathy Scale, and depression was assessed with the Beck Depression Inventory. The secondary analysis was done in all patients recruited. We used a generalised estimating equations (GEE) regression model for individual items and mixed model regression for subscores of the Ardouin scale and the apathy and depression scales. This trial is registered with ClinicalTrials.gov, number NCT00354133. The primary analysis has been reported elsewhere; this report presents the secondary analysis only. FINDINGS Between July, 2006, and November, 2009, 251 participants were recruited, of whom 127 were allocated medical therapy alone and 124 were assigned bilateral subthalamic stimulation plus medical therapy. At 2-year follow-up, the levodopa-equivalent dose was reduced by 39% (-363·3 mg/day [SE 41·8]) in individuals allocated bilateral subthalamic stimulation plus medical therapy and was increased by 21% (245·8 mg/day [40·4]) in those assigned medical therapy alone (p<0·0001). Neuropsychiatric fluctuations decreased with bilateral subthalamic stimulation plus medical therapy during 2-year follow-up (mean change -0·65 points [SE 0·15]) and did not change with medical therapy alone (-0·02 points [0·15]); the between-group difference in change from baseline was significant (p=0·0028). At 2 years, the Ardouin scale subscore for hyperdopaminergic behavioural disorders had decreased with bilateral subthalamic stimulation plus medical therapy (mean change -1·26 points [SE 0·35]) and had increased with medical therapy alone (1·12 points [0·35]); the between-group difference was significant (p<0·0001). Mean change from baseline at 2 years in the Ardouin scale subscore for hypodopaminergic behavioural disorders, the Starkstein Apathy Scale score, and the Beck Depression Inventory score did not differ between treatment groups. Antidepressants were stopped in 12 patients assigned bilateral subthalamic stimulation plus medical therapy versus four patients allocated medical therapy alone. Neuroleptics were started in nine patients assigned medical therapy alone versus one patient allocated bilateral subthalamic stimulation plus medical therapy. During the 2-year follow-up, two individuals assigned bilateral subthalamic stimulation plus medical therapy and one patient allocated medical therapy alone died by suicide. INTERPRETATION In a large cohort with Parkinson's disease and early motor complications, better overall behavioural outcomes were noted with bilateral subthalamic stimulation plus medical therapy compared with medical therapy alone. The presence of hyperdopaminergic behaviours and neuropsychiatric fluctuations can be judged additional arguments in favour of subthalamic stimulation if surgery is considered for disabling motor complications. FUNDING German Federal Ministry of Education and Research, French Programme Hospitalier de Recherche Clinique National, and Medtronic.
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Affiliation(s)
- Eugénie Lhommée
- Movement Disorder Unit, Neurology Department, Centre Hospitalier Universitaire (CHU) Grenoble Alpes, University Grenoble Alpes, Grenoble Institut des Neurosciences (GIN), and Institut National de Santé et en Recherche Médicale (INSERM) U1216, Grenoble, France
| | - Lars Wojtecki
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Virginie Czernecki
- Sorbonne University, Pierre and Marie Curie University Paris 6, Paris, France; Brain and Spine Institute, Paris, France; Neurology Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC) 1422, Paris, France
| | - Karsten Witt
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Franziska Maier
- Department of Neurology, University of Cologne, Cologne, Germany
| | | | - Lars Timmermann
- Department of Neurology, University of Cologne, Cologne, Germany; Department of Neurology, Philipps University of Marburg, Marburg, Germany
| | - Thomas D Hälbig
- NeuroCure Clinical Research Center (NCRC), Charité University Medical Center, Charité (Campus Mitte), Berlin, Germany
| | - Fanny Pineau
- Sorbonne University, Pierre and Marie Curie University Paris 6, Paris, France; Brain and Spine Institute, Paris, France; Neurology Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC) 1422, Paris, France
| | - Franck Durif
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Tatiana Witjas
- Neurology, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Marcus Pinsker
- Department of Neurosurgery, University Hospital, Freiburg, Germany
| | - Maximilian Mehdorn
- Department of Neurosurgery, Universitätsklinikum Schlsewig-Holstein, Kiel, Germany
| | - Friederike Sixel-Döring
- Department of Neurology, Philipps University of Marburg, Marburg, Germany; Paracelsus-Elena-Klinik, Kassel, Germany
| | - Andreas Kupsch
- Department of Neurology and Stereotactic Neurosurgery, University of Magdeburg, and Neurology Moves, Medical Center Bismarck Karrée, Berlin, Germany
| | - Rejko Krüger
- Center of Neurology, and Hertie Institute for Clinical Brain Research, University Hospital, Tübingen, Germany; Luxembourg Centre for Systems Biology, University of Luxembourg, Luxembourg City, Luxembourg; Department of Neurology, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Saskia Elben
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephan Chabardès
- Department of Neurosurgery, Centre Hospitalier Universitaire (CHU) Grenoble Alpes, University Grenoble Alpes, Grenoble Institut des Neurosciences (GIN), and Institut National de Santé et en Recherche Médicale (INSERM) U1216, Grenoble, France
| | - Stéphane Thobois
- Movement Disorder Unit, Neurologie C, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Centre National de la Recherche Scientifique (CNRS), Institut des Sciences Cognitives, Centre de Neurosciences Cognitives, Bron, France; Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Christine Brefel-Courbon
- Neurology Department and Centre Expert Parkinson, University Hospital Toulouse, Toulouse France; INSERM Toulouse NeuroImaging Centre, Toulouse France
| | - Fabienne Ory-Magne
- Neurology Department and Centre Expert Parkinson, University Hospital Toulouse, Toulouse France; INSERM Toulouse NeuroImaging Centre, Toulouse France
| | - Jean-Marie Regis
- Department of Functional Neurosurgery, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - David Maltête
- Department of Neurology, Rouen University Hospital, INSERM U1073, Rouen Faculty of Medicine, Rouen, France
| | - Anne Sauvaget
- Addictology and Liaison-Psychiatry Department, CIC 0004, CHU de Nantes, Hôtel Dieu, Nantes, France
| | - Jörn Rau
- Coordinating Centre for Clinical Trials of the Philipps-University of Marburg, Marburg, Germany
| | - Alfons Schnitzler
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Schüpbach
- Neurology Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC) 1422, Paris, France; Department of Neurology, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | | | - Gunther Deuschl
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Jean-Luc Houeto
- Department of Neurology, CIC-INSERM 1402, CHU de Poitiers; Université de Poitiers, Poitiers, France
| | - Paul Krack
- Movement Disorder Unit, Neurology Department, Centre Hospitalier Universitaire (CHU) Grenoble Alpes, University Grenoble Alpes, Grenoble Institut des Neurosciences (GIN), and Institut National de Santé et en Recherche Médicale (INSERM) U1216, Grenoble, France; Department of Clinical Neurosciences (Neurology), Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Baertschi M, Favez N, Flores Alves Dos Santos J, Radomska M, Herrmann F, Burkhard P, Canuto A, Weber K. The Impact of Deep Brain Stimulation for Parkinson's Disease on Couple Satisfaction: An 18-Month Longitudinal Study. J Clin Psychol Med Settings 2019; 26:461-469. [PMID: 30706305 DOI: 10.1007/s10880-019-09601-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patients with Parkinson's disease (PD) may benefit from deep brain stimulation (DBS) to improve motor and medication-induced symptoms. Yet mixed evidence regarding the outcome of successful DBS on couple satisfaction has been highlighted in the literature. Thirty patients diagnosed with PD were included in a study investigating couple satisfaction (MSS-14), depression (HAD-D) and anxiety (HAD-A) at four measurement times: before DBS and 6, 12, and 18 months post-surgically. Sixteen spouses/partners were included as well. Couple satisfaction from the patient perspective was never associated with depression or anxiety. However, poor marital adjustment (i.e., difference and absolute difference between patients and spouses/partners MSS-14 scores) predicted patients' pre-operative depressive mood. Longitudinal analyses showed that couple satisfaction (n = 9) worsened at 12 months and 18 months compared to pre-DBS scores, F(2.047, 16.378) = 8.723, p = .003, and despite concomitant motor improvement. Growth curve analyses showed that couple satisfaction worsening occurred between 6 and 12 months post-operatively (b = 2.938, p < .001). Thus, couple satisfaction did not increase along with motor improvement and deteriorated after the adjustment period following DBS.
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Affiliation(s)
- Marc Baertschi
- Faculty of Psychology, University of Geneva, Boulevard du Pont-d'Arve 40, 1205, Geneva, Switzerland. .,Service of General Psychiatry and Psychotherapy, Nant Foundation, Avenue des Alpes 66, 1820, Montreux, Switzerland.
| | - Nicolas Favez
- Faculty of Psychology, University of Geneva, Boulevard du Pont-d'Arve 40, 1205, Geneva, Switzerland
| | - João Flores Alves Dos Santos
- Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.,Liaison Psychiatry and Emergency Psychiatric Center, Neuchatel Psychiatric Center, Maladière 45, 2000, Neuchâtel, Switzerland
| | - Michalina Radomska
- Faculty of Psychology, University of Geneva, Boulevard du Pont-d'Arve 40, 1205, Geneva, Switzerland
| | - François Herrmann
- Division of Geriatrics, Geneva University Hospitals, Chemin du Pont-Bochet 3, 1226, Thônex, Switzerland
| | - Pierre Burkhard
- Service of Neurology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Alessandra Canuto
- Executive and General Management Service, Hôpital de Nant, Nant Foundation, 1804, Corsier-sur-Vevey, Switzerland
| | - Kerstin Weber
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Les Voirons - Chemin du Petit-Bel-Air 2, 1225, Chêne-Bourg, Switzerland
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Tandra S, Ramavath B, Kandadai RM, Jabeen SA, Kannan MA, Borgohain R. Functional Outcome of Bilateral Subthalamic Nucleus-Deep Brain Stimulation in Advanced Parkinson's Disease Patients: A Prospective Study. Ann Indian Acad Neurol 2019; 23:54-58. [PMID: 32055123 PMCID: PMC7001439 DOI: 10.4103/aian.aian_357_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Deep brain stimulation (DBS) is an accepted modality of treatment in patients with Parkinson's disease (PD). Although DBS was approved in advanced PD, it is being done in early PD as well. It was mainly developed to help the patients of PD to overcome the adverse motor effects associated with treatment and treatment failure. Objective: The objective is to study the efficacy of subthalamic nucleus (STN)-DBS procedure in patients with PD. Materials and Methods: This was a prospective, single-center, follow-up observational study using a direct, structured interview of 40 selected PD patients. Preoperative assessment using Unified PD Rating Scale-III (UPDRS-III), Montreal Cognitive Assessment (MOCA), and Parkinson's Disease Questionnaire-39 were done. All the patients underwent DBS. Postoperatively, similar assessment was done during follow-up period of 6 months. The results were analyzed using Student's t-test. Results: The total score of UPDRS-III was reduced by 35% after STN-DBS intervention which was statistically significant (P < 0.05). STN-DBS intervention was successful in significantly reducing all UPDRS-III subscores but failed to reduce the scores in case of postural stability. MOCA scores of the patients were not found to be affected by STN-DBS intervention (P = 0.1466). Similar findings were also observed for MOCA subscores, but there was significant improvement of verbal fluency in all patients. Quality of life(QoL) improved significantly in all patients after STN-DBS intervention in all areas. Lower baseline UPDRS-III scores were found to enhance the QoL both in “off” and “on” state. However, prolonged disease duration and older age at PD onset were found to be hampering factors in the improvement of QoL. Conclusions: STN-DBS is a safe procedure and can be performed in all patients of PD who develop disabling motor fluctuations to improve their QoL irrespective early or advanced disease.
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Affiliation(s)
- Swetha Tandra
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Balakrishna Ramavath
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - S A Jabeen
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Meena A Kannan
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Foley JA, Foltynie T, Limousin P, Cipolotti L. Standardised Neuropsychological Assessment for the Selection of Patients Undergoing DBS for Parkinson's Disease. PARKINSON'S DISEASE 2018; 2018:4328371. [PMID: 29971141 PMCID: PMC6009029 DOI: 10.1155/2018/4328371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/23/2018] [Accepted: 04/30/2018] [Indexed: 11/17/2022]
Abstract
DBS is an increasingly offered advanced treatment for Parkinson's disease (PD). Neuropsychological assessment is considered to be an important part of the screening for selection of candidates for this treatment. However, no standardised screening procedure currently exists. In this study, we examined the use of our standardised neuropsychological assessment for the evaluation of surgical candidates and to identify risk factors for subsequent decline in cognition and mood. A total of 40 patients were assessed before and after DBS. Evaluation of mood and case notes review was also undertaken. Before DBS, patients with PD demonstrated frequent impairments in intellectual functioning, memory, attention, and executive function, as well as high rates of mood disorder. Post-DBS, there was a general decline in verbal fluency only, and in one patient, we documented an immediate and irreversible global cognitive decline, which was associated with older age and more encompassing cognitive deficits at baseline. Case note review revealed that a high proportion of patients developed mood disorder, which was associated with higher levels of depression at baseline and greater reduction in levodopa medication. We conclude that our neuropsychological assessment is suitable for the screening of candidates and can identify baseline risk factors, which requires careful consideration before and after surgery.
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Affiliation(s)
- Jennifer A. Foley
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Tom Foltynie
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Patricia Limousin
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Lisa Cipolotti
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo, Palermo, Italy
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Viaña JNM, Gilbert F. Deep brain stimulation for people with Alzheimer's disease: Anticipating potential effects on the tripartite self. DEMENTIA 2018. [PMID: 29528701 DOI: 10.1177/1471301218761147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Memory dysfunction and cognitive impairments due to Alzheimer’s disease can affect the selfhood and identity of afflicted individuals, causing distress to both people with Alzheimer’s disease and their caregivers. Recently, a number of case studies and clinical trials have been conducted to determine the potential of deep brain stimulation as a therapeutic modality for people with Alzheimer’s disease. Some of these studies have shown that deep brain stimulation could induce flashbacks and stabilize or even improve memory. However, deep brain stimulation itself has also been attributed as a potential threat to identity and selfhood, especially when procedure-related adverse events arise. We anticipate potential effects of deep brain stimulation for people with Alzheimer’s disease on selfhood, reconciling information from medical reports, psychological, and sociological investigations on the impacts of deep brain stimulation or Alzheimer’s disease on selfhood. A tripartite model of the self that extends the scope of Rom Harré’s and Steve Sabat’s social constructionist framework was used. In this model, potential effects of deep brain stimulation for Alzheimer’s disease on Self 1 or singularity through use of first-person indexicals, and gestures of self-reference, attribution, and recognition; Self 2 or past and present attributes, knowledge of these characteristics, and continuity of narrative identity; and Self 3 or the relational and social self are explored. The ethical implications of potential effects of deep brain stimulation for Alzheimer’s disease on the tripartite self are then highlighted, focusing on adapting informed consent procedures and care provided throughout the trial to account for both positive and negative plausible effects on Self 1, Self 2, and Self 3.
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Affiliation(s)
- John Noel M Viaña
- Wicking Dementia Research and Education Centre, College of Health and Medicine; Ethics, Policy and Public Engagement Program, Australian Research Council Centre of Excellence for Electromaterials Science; Philosophy and Gender Studies Program, School of Humanities, College of Arts, Law, and Education, University of Tasmania, Hobart, Australia
| | - Frederic Gilbert
- Center for Sensorimotor Neural Engineering and Department of Philosophy, University of Washington, Seattle, WA, USA; Ethics, Policy and Public Engagement Program, Australian Research Council Centre of Excellence for Electromaterials Science, University of Tasmania, Hobart, Australia
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Chagraoui A, Boukhzar L, Thibaut F, Anouar Y, Maltête D. The pathophysiological mechanisms of motivational deficits in Parkinson's disease. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:138-152. [PMID: 29097256 DOI: 10.1016/j.pnpbp.2017.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/21/2017] [Accepted: 10/30/2017] [Indexed: 12/23/2022]
Abstract
Parkinson's disease (PD) is a progressive degenerative disorder that leads to disabling motor symptoms and a wide variety of neuropsychiatric symptoms. Apathy is the most common psychiatric disorder in the early stages of untreated PD and can be defined as a hypodopaminergic syndrome, which also includes anxiety and depression. Apathy is also considered the core feature of the parkinsonian triad (apathy, anxiety and depression) of behavioural non-motor signs, including a motivational deficit. Moreover, apathy is recognised as a distinct chronic neuropsychiatric behavioural disorder based on specific diagnostic criteria. Given the prevalence of apathy in approximately 40% of the general Parkinson's disease population, this appears to be a contributing factor to dementia in PD; also, apathy symptoms are factors that potentially contribute to morbidity, leading to a major impairment of health-related quality of life, thus stressing the importance of understanding the pathophysiology of this disease. Several studies have clearly established a prominent role for DA-mediated signals in PD apathy. However, synergistic interaction between dopaminergic impairment resulting from the neurodegenerative process and deep brain stimulation of the subthalamic nucleus may cause or exacerbate apathy. Furthermore, serotoninergic mechanism signalling is also likely to be of importance in this pathophysiology.
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Affiliation(s)
- A Chagraoui
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France.; Department of Medical Biochemistry, Rouen University Hospital, Rouen, France.
| | - L Boukhzar
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France
| | - F Thibaut
- Department of Psychiatry, University Hospital Cochin (site Tarnier), University of Paris-Descartes and INSERM U 894 Laboratory of Psychiatry and Neurosciences, Paris, France
| | - Y Anouar
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France
| | - D Maltête
- Department of Neurology, Rouen University Hospital, Rouen, France
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Omarova SM, Fedorova NV, Tomskiy AA, Gamaleya AA, Bril' EV, Gubareva NN, Poddubskaya AA. [Syndrome dopamine dysregulation and deep brain stimulation of the subthalamic nucleus in Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 117:27-32. [PMID: 29376980 DOI: 10.17116/jnevro201711712127-32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Dopamine dysregulation syndrome (DDS) is a complication of the dopaminergic therapy in Parkinson's disease (PD); it is manifested as a compulsive medication use and may have negative impact on patients' social, psychological, and physical functioning. An effect of deep brain stimulation in the subthalamic nucleus (DBS STN) on DDS is not fully understood. Therefore, the degree of DDS during DBS STN in PD patients was evaluated in the study. MATERIAL AND METHODS The main group included 15 patients with DDS symptoms in the preoperative period. The comparison group consisted of 15 patients without DDS symptoms and the control group consisted of 15 patients who did not undergo surgery. RESULTS AND CONCLUSION The severity of motor disturbances in the surgery groups has decreased significantly (by 45%). Motor complications during DBS STN in patients with DDS have decreased by 50%; a decrease in the reduction of doses of dopaminergic preparations was noted as well.
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Affiliation(s)
- S M Omarova
- Russian Medical Academy of Continuing Postgraduate Education, Moscow, Russia
| | - N V Fedorova
- Russian Medical Academy of Continuing Postgraduate Education, Moscow, Russia
| | - A A Tomskiy
- Burdenko National Research Centre of Neurosurgery, Moscow, Russia
| | - A A Gamaleya
- Burdenko National Research Centre of Neurosurgery, Moscow, Russia
| | - E V Bril'
- Russian Medical Academy of Continuing Postgraduate Education, Moscow, Russia
| | - N N Gubareva
- Russian Medical Academy of Continuing Postgraduate Education, Moscow, Russia
| | - A A Poddubskaya
- Burdenko National Research Centre of Neurosurgery, Moscow, Russia
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46
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Doleys DM, Dolce JJ. Psychological Issues and Evaluation for Patients Undergoing Implantable Technology. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Wang D, Liu X, Zhou B, Kuang W, Guo T. Advanced research on deep brain stimulation in treating mental disorders. Exp Ther Med 2017; 15:3-12. [PMID: 29250146 DOI: 10.3892/etm.2017.5366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 07/10/2017] [Indexed: 11/05/2022] Open
Abstract
Deep brain stimulation is a method that involves using an electric stimulus on a specific target in the brain with stereotaxis. It is a minimally invasive, safe, adjustable and reversible nerve involvement technology. At present, this technique is widely applied to treat movement disorders and has produced promising effects on mental symptoms, including combined anxiety and depression. Deep brain stimulation has therefore been employed as a novel treatment for depression, obsessive-compulsive disorder, habituation, Tourette's syndrome, presenile dementia, anorexia nervosa and other refractory mental illnesses. Many encouraging results have been reported. The aim of the present review was to briefly describe the mechanisms, target selection, side effects, ethical arguments and risks associated with deep brain stimulation. Although deep brain stimulation is a developing and promising treatment, a large amount of research is still required to determine its curative effect, and the selection of patients and targets must be subjected to strict ethical standards.
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Affiliation(s)
- Dongxin Wang
- Mental Health Institute of Hunan Province, The Brain Hospital of Hunan Province, Changsha, Hunan 410007, P.R. China
| | - Xuejun Liu
- Mental Health Institute of Hunan Province, The Brain Hospital of Hunan Province, Changsha, Hunan 410007, P.R. China
| | - Bin Zhou
- Surgery Department of Mental Disease, The Brain Hospital of Hunan Province, Changsha, Hunan 410007, P.R. China
| | - Weiping Kuang
- Surgery Department of Mental Disease, The Brain Hospital of Hunan Province, Changsha, Hunan 410007, P.R. China
| | - Tiansheng Guo
- Mental Health Institute of Hunan Province, The Brain Hospital of Hunan Province, Changsha, Hunan 410007, P.R. China
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48
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Ienca M, Andorno R. Towards new human rights in the age of neuroscience and neurotechnology. LIFE SCIENCES, SOCIETY AND POLICY 2017; 13:5. [PMID: 28444626 PMCID: PMC5447561 DOI: 10.1186/s40504-017-0050-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/20/2017] [Indexed: 05/10/2023]
Abstract
Rapid advancements in human neuroscience and neurotechnology open unprecedented possibilities for accessing, collecting, sharing and manipulating information from the human brain. Such applications raise important challenges to human rights principles that need to be addressed to prevent unintended consequences. This paper assesses the implications of emerging neurotechnology applications in the context of the human rights framework and suggests that existing human rights may not be sufficient to respond to these emerging issues. After analysing the relationship between neuroscience and human rights, we identify four new rights that may become of great relevance in the coming decades: the right to cognitive liberty, the right to mental privacy, the right to mental integrity, and the right to psychological continuity.
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Affiliation(s)
- Marcello Ienca
- Institute for Biomedical Ethics, University of Basel, Bernouillstrasse 28, 4056, Basel, Switzerland.
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49
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Mehanna R, Bajwa JA, Fernandez H, Wagle Shukla AA. Cognitive Impact of Deep Brain Stimulation on Parkinson's Disease Patients. PARKINSON'S DISEASE 2017; 2017:3085140. [PMID: 29359065 PMCID: PMC5735627 DOI: 10.1155/2017/3085140] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/15/2017] [Accepted: 10/16/2017] [Indexed: 11/17/2022]
Abstract
Subthalamic nucleus (STN) or globus pallidus interna (GPi) deep brain stimulation (DBS) is considered a robust therapeutic tool in the treatment of Parkinson's disease (PD) patients, although it has been reported to potentially cause cognitive decline in some cases. We here provide an in-depth and critical review of the current literature regarding cognition after DBS in PD, summarizing the available data on the impact of STN and GPi DBS as monotherapies and also comparative data across these two therapies on 7 cognitive domains. We provide evidence that, in appropriately screened PD patients, worsening of one or more cognitive functions is rare and subtle after DBS, without negative impact on quality of life, and that there is very little data supporting that STN DBS has a worse cognitive outcome than GPi DBS.
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Affiliation(s)
- Raja Mehanna
- University of Texas Health Science Center, Houston, TX, USA
| | - Jawad A. Bajwa
- Parkinson's, Movement Disorders and Neurorestoration Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hubert Fernandez
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
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50
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Enrici I, Mitkova A, Castelli L, Lanotte M, Lopiano L, Adenzato M. Deep Brain Stimulation of the subthalamic nucleus does not negatively affect social cognitive abilities of patients with Parkinson's disease. Sci Rep 2017; 7:9413. [PMID: 28842656 PMCID: PMC5573348 DOI: 10.1038/s41598-017-09737-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/19/2017] [Indexed: 12/19/2022] Open
Abstract
Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a treatment option for patients with advanced idiopathic PD successful at alleviating disabling motor symptoms. Nevertheless, the effects of STN-DBS on cognitive functions remain controversial and few studies have investigated modification of social cognitive abilities in patients with PD treated with STN-DBS. Here we expanded the typically-investigated spectrum of these abilities by simultaneously examining emotion recognition, and both affective and cognitive Theory of Mind (ToM). By means of a cross-sectional study, 20 patients with PD under dopaminergic replacement therapy, 18 patients with PD treated with STN-DBS, and 20 healthy controls performed the Ekman 60-Faces test, the full version of the Reading the Mind in the Eyes test, and the Protocol for the Attribution of Communicative Intentions. There were no differences between the PD groups (treated and not treated with STN-DBS) on any of the social cognitive tests. Our results suggest that patients with PD who are treated with STN-DBS do not experience detrimental effects on their social cognitive abilities. The present study, the first one examining a wide spectrum of social cognitive abilities after DBS of the STN, suggests that this surgical procedure can be considered safe from this standpoint.
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Affiliation(s)
- Ivan Enrici
- Department of Philosophy and Educational Sciences, University of Turin, Turin, Italy.,Center for Cognitive Science, University of Turin, Turin, Italy.,Neuroscience Institute of Turin, Turin, Italy
| | - Antonia Mitkova
- Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Ospedale S. Giuseppe, Piancavallo, VCO, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy.
| | - Michele Lanotte
- Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Mauro Adenzato
- Center for Cognitive Science, University of Turin, Turin, Italy.,Neuroscience Institute of Turin, Turin, Italy.,Department of Psychology, University of Turin, Turin, Italy
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