title: Impact of Combined Subthalamic Nucleus and Substantia Nigra Stimulation on Neuropsychiatric Symptoms in Parkinson's Disease Patients.
abstract: The goal of the study was to compare the tolerability and the effects of conventional subthalamic nucleus (STN) and combined subthalamic nucleus and substantia nigra (STN+SNr) high-frequency stimulation in regard to neuropsychiatric symptoms in Parkinson's disease patients. In this single center, randomized, double-blind, cross-over clinical trial, twelve patients with advanced Parkinson's disease (1 female; age: 61.3 ± 7.3 years; disease duration: 12.3 ± 5.4 years; Hoehn and Yahr stage: 2.2 ± 0.39) were included. Apathy, fatigue, depression, and impulse control disorder were assessed using a comprehensive set of standardized rating scales and questionnaires such as the Lille Apathy Rating Scale (LARS), Modified Fatigue Impact Scale (MFIS), Becks Depression Inventory (BDI-I), Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP-RS), and Parkinson's Disease Questionnaire (PDQ-39). Three patients that were initially assigned to the STN+SNr stimulation mode withdrew from the study within the first week due to discomfort. Statistical comparison of data retrieved from patients who completed the study revealed no significant differences between both stimulation conditions in terms of mean scores of scales measuring apathy, fatigue, depression, impulse control disorder, and quality of life. Individual cases showed an improvement of apathy under combined STN+SNr stimulation. In general, combined STN+SNr stimulation seems to be safe in terms of neuropsychiatric side effects, although careful patient selection and monitoring in the short-term period after changing stimulation settings are recommended.
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: U
authors.identifier: 0000-0001-8016-1821
authors.initials: U
authors.lastname: Hidding
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: A
authors.identifier: 0000-0003-0538-5109
authors.initials: A
authors.lastname: Gulberti
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Horn
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: C
authors.identifier: 0000-0001-8540-3789
authors.initials: C
authors.lastname: Buhmann
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Hamel
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: J A
authors.initials: JA
authors.lastname: Koeppen
authors.affiliation: Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Westphal
authors.affiliation: Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: A K
authors.initials: AK
authors.lastname: Engel
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Gerloff
authors.affiliation: Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany.
authors.forename: D
authors.identifier: 0000-0003-0447-7132
authors.initials: D
authors.lastname: Weiss
authors.affiliation: Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: C K E
authors.initials: CK
authors.lastname: Moll
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: M
authors.identifier: 0000-0001-7680-2147
authors.initials: M
authors.lastname: Pötter-Nerger