title: Acute and Chronic Mood and Apathy Outcomes from a randomized study of unilateral STN and GPi DBS.
abstract: OBJECTIVE
  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).
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America; Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
authors.affiliation: Department of Biostatistics, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.affiliation: Department of Psychiatry, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.
authors.forename: Sarah
authors.initials: S
authors.lastname: Fayad
authors.affiliation: Department of Psychiatry, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.
authors.forename: Herbert
authors.initials: H
authors.lastname: Ward
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America; Department of Clinical and Health Psychology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.
authors.forename: Dawn
authors.initials: D
authors.lastname: Bowers
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.
authors.forename: Christian
authors.initials: C
authors.lastname: Rosado
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.
authors.forename: Lauren
authors.initials: L
authors.lastname: Bowen
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.
authors.forename: Charles
authors.initials: C
authors.lastname: Jacobson
authors.affiliation: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States of America.
authors.forename: Christopher
authors.initials: C
authors.lastname: Butson
authors.affiliation: Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Foote
mesh_terms: D000208:Acute Disease; D000368:Aged; D057565:Apathy; D002908:Chronic Disease; D015331:Cohort Studies; D046690:Deep Brain Stimulation; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology / Q000628:therapy*; D010300:Parkinson Disease / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D011569:Psychiatric Status Rating Scales; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D016896:Treatment Outcome