title: The combined effect of subthalamic nuclei deep brain stimulation and L-dopa increases emotion recognition in Parkinson's disease.
abstract: Deep brain stimulation of the subthalamic nucleus (DBS) is a widely used surgical technique to suppress motor symptoms in Parkinson's disease (PD), and as such improves patients' quality of life. However, DBS may produce emotional disorders such as a reduced ability to recognize emotional facial expressions (EFE). Previous studies have not considered the fact that DBS and l-dopa medication can have differential, common, or complementary consequences on EFE processing. A thorough way of investigating the effect of DBS and l-dopa medication in greater detail is to compare patients' performances after surgery, with the two therapies either being administered ('on') or not administered ('off'). We therefore used a four-condition (l-dopa 'on'/DBS 'on', l-dopa 'on'/DBS 'off', l-dopa 'off'/DBS 'on', and l-dopa 'off'/DBS 'off') EFE recognition paradigm and compared implanted PD patients to healthy controls. The results confirmed those of previous studies, yielding a significant impairment in the detection of some facial expressions relative to controls. Disgust recognition was impaired when patients were 'off' l-dopa and 'on' DBS, and fear recognition impaired when 'off' of both therapies. More interestingly, the combined effect of both DBS and l-dopa administration seems much more beneficial for EFE recognition than the separate administration of each individual therapy. We discuss the implications of these findings in the light of the inverted U curve function that describes the differential effects of dopamine level on the right orbitofrontal cortex (OFC). We propose that, while l-dopa could "overdose" in dopamine the ventral stream of the OFC, DBS would compensate for this over-activation by decreasing OFC activity, thereby restoring the necessary OFC-amygdala interaction. Another finding is that, when collapsing over all treatment conditions, PD patients recognized more neutral faces than the matched controls, a result that concurs with embodiment theories.
authors.affiliation: LAPSCO (UMR 6024), Blaise Pascal University, Clermont-Ferrand 63000, France. Electronic address: Laurie.Mondillon@univ-savoie.fr.
authors.forename: Laurie
authors.initials: L
authors.lastname: Mondillon
authors.affiliation: LAPSCO (UMR 6024), Blaise Pascal University, Clermont-Ferrand 63000, France; Institut Universitaire de France, Paris 75005, France.
authors.forename: Martial
authors.initials: M
authors.lastname: Mermillod
authors.affiliation: CRPCC (EA 1285), European University of Brittany, Rennes 35000, France.
authors.forename: Serban C
authors.initials: SC
authors.lastname: Musca
authors.affiliation: Neurology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France; UFR Medecine, University of Clermont 1, Clermont-Ferrand F-63009, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rieu
authors.affiliation: Neurology Department, Resource and Research Memory Center (CMRR), CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France.
authors.forename: Tiphaine
authors.initials: T
authors.lastname: Vidal
authors.affiliation: LAPSCO (UMR 6024), Blaise Pascal University, Clermont-Ferrand 63000, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Chambres
authors.affiliation: Neurology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Auxiette
authors.affiliation: Ophtalmology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Dalens
authors.affiliation: Ophtalmology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France.
authors.forename: Louise
authors.initials: L
authors.lastname: Marie Coulangeon
authors.affiliation: UFR Medecine, University of Clermont 1, Clermont-Ferrand F-63009, France; Psychiatry A Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jalenques
authors.affiliation: UFR Medecine, University of Clermont 1, Clermont-Ferrand F-63009, France; Neurosurgery Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Lemaire
authors.affiliation: Neurology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ulla
authors.affiliation: Neurology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Derost
authors.affiliation: Neurology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France; UFR Medecine, University of Clermont 1, Clermont-Ferrand F-63009, France.
authors.forename: Ana
authors.initials: A
authors.lastname: Marques
authors.affiliation: Neurology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France; UFR Medecine, University of Clermont 1, Clermont-Ferrand F-63009, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Durif
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation / Q000523:psychology*; D004644:Emotions; D005149:Facial Expression; D005260:Female; D005625:Frontal Lobe / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology / Q000628:therapy*; D010364:Pattern Recognition, Visual / Q000187:drug effects*; D010468:Perceptual Disorders / Q000188:drug therapy* / Q000209:etiology; D020531:Subthalamic Nucleus / Q000187:drug effects* / Q000503:physiopathology
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa