title: Chronic stress-like syndrome as a consequence of medial site subthalamic stimulation in Parkinson's disease.
abstract: Considering the functional organization of the subthalamic nucleus (STN), we hypothesized that subthalamic deep brain stimulation (STN-DBS) in Parkinson's disease might have a differential impact on the hypothalamic-pituitary-adrenal axis in relation to the position of active stimulating contact within the STN. In addition, we searched for any STN-DBS-related morning plasma cortisol changes in association with postoperative anxiety and weight gain. A plasma cortisol measurement was performed on the day of initiation of bilateral STN-DBS and repeated after 1 and 17 months in twenty patients with advanced Parkinson's disease. The body weight change and anxiety scores following the implantation were assessed as well. The electrode positions in the STN were determined on T1-weighted magnetic resonance images. After initiation of stimulation, cortisol levels significantly decreased and the cortisol changes after 1 and 17 months strongly correlated with the position of active contact in the subthalamic area. Patients with at least one contact located more medially in the STN experienced a significantly greater decrease of cortisol than those with one or both active contacts more laterally. Furthermore, the lower cortisol levels were strongly associated with higher trait anxiety and weight gain. These changes mimicked the effects of chronic stress and suggest the disturbing impact of STN-DBS on limbic and motivational systems.
authors.affiliation: Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic.
authors.forename: Filip
authors.initials: F
authors.lastname: Růžička
authors.affiliation: Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic. Electronic address: jech@cesnet.cz.
authors.forename: Robert
authors.initials: R
authors.lastname: Jech
authors.affiliation: Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic.
authors.forename: Lucie
authors.initials: L
authors.lastname: Nováková
authors.affiliation: Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.
authors.forename: Dušan
authors.initials: D
authors.lastname: Urgošík
authors.affiliation: Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Bezdíček
authors.affiliation: Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Department of Radiology, Na Homolce Hospital, Prague, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Vymazal
authors.affiliation: Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic.
authors.forename: Evžen
authors.initials: E
authors.lastname: Růžička
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000097:blood / Q000209:etiology; D002908:Chronic Disease; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000097:blood / Q000628:therapy*; D013315:Stress, Psychological / Q000097:blood / Q000209:etiology; D020531:Subthalamic Nucleus / Q000601:surgery; D015430:Weight Gain / Q000502:physiology*
chemical_list: D006854:Hydrocortisone
keywords: Anxiety; Cortisol; Deep brain stimulation; Stress; Subthalamic nucleus; Weight gain