Apathy following subthalamic stimulation in Parkinson disease: a dopamine responsive symptom.
To evaluate the effects of the dopamine D2-D3 agonist ropinirole in patients who developed apathy after complete withdrawal from dopaminergic medication following successful subthalamic nucleus (STN) stimulation for advanced Parkinson disease (PD). We assessed apathy (Apathy Scale, Apathy Inventory), mood (Montgomery-Asberg Depression Rating Scale), cognitive functions (Mattis Dementia rating scale, frontal score, executive tests) and motor state (UPDRS-III) in 8 PD patients treated with STN stimulation without dopaminergic treatment and who became apathetic. Assessments were made at baseline and after 6 weeks of ropinirole treatment (7.2 +/- 5.9 mg/d; range 1-18 mg/d). Apathy improved with ropinirole in all but 1 patient (54 +/- 24%; range 0-78%). Mood also improved (75 +/- 31%; range 0-100%), but not in correlation with the change in apathy. Cognitive performance was not modified. Stimulation contacts were located within the STN in all patients except the one who remained apathetic in spite of ropinirole treatment (zona incerta). We suggest that apathy, which was compensated for by an enhancement of D2-D3 receptor stimulation in PD patients with STN stimulation: (1) depends on a dopaminergic deficit in associativo-limbic areas of the brain and (2) can be avoided if a dopaminergic agonist is administered postoperatively.
Czernecki
Virginie
V
Center d'Investigation Clinique, Fédération de Neurologie, INSERM Unit 679, Paris, France.|INSERM Unit 610, Paris, France.
Schüpbach
Michael
M
Center d'Investigation Clinique, Fédération de Neurologie, INSERM Unit 679, Paris, France.|Department of Neurology, University Hospital, Bern, Switzerland.
Yaici
Sadek
S
Center d'Investigation Clinique, Fédération de Neurologie, INSERM Unit 679, Paris, France.
Lévy
Richard
R
INSERM Unit 610, Paris, France.
Bardinet
Eric
E
CNRS-UPR640, CHU Pitié-Salpêtrière, Université Pierre et Marie Curie-Paris 6, Paris, France.
Yelnik
Jérôme
J
Center d'Investigation Clinique, Fédération de Neurologie, INSERM Unit 679, Paris, France.
Dubois
Bruno
B
INSERM Unit 610, Paris, France.
Agid
Yves
Y
Center d'Investigation Clinique, Fédération de Neurologie, INSERM Unit 679, Paris, France.
D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007211:Indoles / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology*; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D017448:Receptors, Dopamine D2 / Q000187:drug effects; D050637:Receptors, Dopamine D3 / Q000187:drug effects; D020531:Subthalamic Nucleus / Q000503:physiopathology*
D018491:Dopamine Agonists; D007211:Indoles; D017448:Receptors, Dopamine D2; D050637:Receptors, Dopamine D3; C046649:ropinirole