Acute and Chronic Mood and Apathy Outcomes from a randomized study of unilateral STN and GPi DBS

• Published in: PloS one Vol. 9; no. 12; p. e114140
• Main Authors: Okun, Michael S, Wu, Samuel S, Fayad, Sarah, Ward, Herbert, Bowers, Dawn, Rosado, Christian, Bowen, Lauren, Jacobson, Charles, Butson, Christopher, Foote, Kelly D
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.12.2014; Public Library of Science (PLoS)
• Subjects: Acute Disease; Affective disorders; Aged; Anxiety; Apathy; Biology and Life Sciences; Brain; Chronic Disease; Cohort Studies; Deep Brain Stimulation; Depression (Mood disorder); Dopamine receptors; Drugs; Electrical stimuli; Emotional behavior; Female; Follow-Up Studies; Globus pallidus; Globus Pallidus - physiopathology; Humans; Male; Medicine and Health Sciences; Mental depression; Middle Aged; Mood; Mood Disorders - psychology; Mood Disorders - therapy; Movement disorders; Neurodegenerative diseases; Neurology; Neurosciences; Neurosurgery; Obsessive compulsive disorder; Parkinson disease; Parkinson Disease - diagnosis; Parkinson Disease - psychology; Parkinson Disease - therapy; Parkinson's disease; Patients; Psychiatric Status Rating Scales; Psychiatry; Randomization; Reduction; Satellite television industry; Solitary tract nucleus; Subthalamic nucleus; Subthalamic Nucleus - physiopathology; Surgery; Surgical implants; Therapists; Treatment Outcome
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0114140

To study mood and behavioral effects of unilateral and staged bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) for Parkinson's disease (PD). There are numerous reports of mood changes following DBS, however, most have focused on bilateral simultaneous STN implants with rapid and aggressive post-operative medication reduction. A standardized evaluation was applied to a subset of patients undergoing STN and GPi DBS and who were also enrolled in the NIH COMPARE study. The Unified Parkinson Disease Rating Scale (UPDRS III), the Hamilton depression (HAM-D) and anxiety rating scales (HAM-A), the Yale-Brown obsessive-compulsive rating scale (YBOCS), the Apathy Scale (AS), and the Young mania rating scale (YMRS) were used. The scales were repeated at acute and chronic intervals. A post-operative strategy of non-aggressive medication reduction was employed. Thirty patients were randomized and underwent unilateral DBS (16 STN, 14 GPi). There were no baseline differences. The GPi group had a higher mean dopaminergic dosage at 1-year, however the between group difference in changes from baseline to 1-year was not significant. There were no differences between groups in mood and motor outcomes. When combining STN and GPi groups, the HAM-A scores worsened at 2-months, 4-months, 6-months and 1-year when compared with baseline; the HAM-D and YMRS scores worsened at 4-months, 6-months and 1-year; and the UPDRS Motor scores improved at 4-months and 1-year. Psychiatric diagnoses (DSM-IV) did not change. No between group differences were observed in the cohort of bilateral cases. There were few changes in mood and behavior with STN or GPi DBS. The approach of staging STN or GPi DBS without aggressive medication reduction could be a viable option for managing PD surgical candidates. A study of bilateral DBS and of medication reduction will be required to better understand risks and benefits of a bilateral approach.