Acute psychotropic effects of bilateral subthalamic nucleus stimulation and levodopa in Parkinson's disease.
High-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves the motor symptoms of Parkinson's disease (PD). Opposite changes in mood, such as mania or depression, have been reported after surgery, but it is not known whether these side effects are specifically related to STN DBS. To learn whether STN DBS also influences the limbic loop, we investigated acute subjective psychotropic effects related to levodopa or bilateral STN DBS. After a median postoperative follow-up of 12 months, 50 PD patients completed the Addiction Research Center Inventory (ARCI), assessing subjective psychotropic effects in four conditions: off-drug/on-stimulation; off-drug/off-stimulation; on-drug/off-stimulation; and on-drug/on-stimulation. Both levodopa and STN DBS improved all the ARCI subscales, indicating subjective feelings of well being, euphoria, increase in motivation, and decrease in fatigue, anxiety, and tension. A suprathreshold dose of levodopa was significantly more effective than STN DBS, using the same electrical parameters as for chronic stimulation, on four of the five ARCI subscales. We concluded that 1) both STN DBS and levodopa have synergistic acute beneficial psychotropic effects in PD, 2) the psychotropic effects of both treatments need to be considered in the long-term management of chronic STN DBS, and 3) the results indicate an involvement of the limbic STN in mood disorders of PD.
Department of Clinical and Biological Neurosciences, Joseph Fourier University, Grenoble, France.
Aurélie
A
Funkiewiez
Claire
C
Ardouin
Paul
P
Krack
Valérie
V
Fraix
Nadège
N
Van Blercom
Jing
J
Xie
Elena
E
Moro
Alim-Louis
AL
Benabid
Pierre
P
Pollak
D000203:Activities of Daily Living; D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology; D003865:Major Depressive Disorder / Q000175:diagnosis; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D007839:Functional Laterality; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D011581:Psychological Tests; D011596:Psychomotor Disorders / Q000175:diagnosis*; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000502:physiology*; D011795:Surveys and Questionnaires; D013995:Time
D000978:Antiparkinson Agents; D007980:Levodopa