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Vol. 55, No. 3, 2006
Issue release date: June 2006
Section title: Original Paper
Eur Neurol 2006;55:136–144
(DOI:10.1159/000093213)

Chronic Deep Brain Stimulation of the Subthalamic Nucleus for Parkinson’s Disease: Effects on Cognition, Mood, Anxiety and Personality Traits

Castelli L. · Perozzo P. · Zibetti M. · Crivelli B. · Morabito U. · Lanotte M. · Cossa F. · Bergamasco B. · Lopiano L.
aDepartment of Neuroscience, University of Turin, and bDepartment of Neuromotor Rehabilitation, Casa di Cura Major, S. Maugeri Foundation, Turin, Italy

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 12/1/2005
Accepted: 3/2/2006
Published online: 6/23/2006

Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 6

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: http://www.karger.com/ENE

Abstract

Objective: To evaluate modifications occurring in cognitive functions and behavioural aspects in a group of 72 consecutive patients with Parkinson’s disease (PD) 15 months after bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN). Methods: 72 consecutive PD patients bilaterally implanted for DBS of the STN were evaluated before and after surgery with a mean follow-up of 15 months. A neuropsychological assessment was performed to evaluate reasoning (Raven Colour Matrices), memory (Bisyllabic Word Repetition Test, Corsi’s Block-Tapping Test, Paired-Associate Learning) and frontal executive functions (Trail Making Test Part B, Nelson Modified Card Sorting Test, phonemic and category verbal fluency tasks). Mood and suicidal ideation were evaluated using the Beck Depression Inventory (BDI). Anxiety was measured by means of the State-Trait Anxiety Inventory and personality traits were evaluated with the Structured Clinical Interview for the DSM-III-R Axis II Disorders (SCID-II). Assessment of thought disorders and apathy was based on subitems of the Unified Parkinson’s Disease Rating Scale. Results: The comparisons between pre- and postoperative neuropsychological test scores showed a significant worsening only in phonemic and semantic verbal fluency tasks, while fewer errors were found in the Nelson Modified Card Sorting Test. Globally, behavioural assessment evidenced a small improvement in mood, as assessed by the BDI, in obsessive-compulsive and paranoid personality traits (SCID-II). Thought disorders worsened while suicidal ideation, anxiety and apathy showed no postoperative modifications. The analysis of individual outcomes (±1 SD criterion) evidenced a relevant postoperative cognitive decline in 3 patients out of 65 (4.5%). Moreover, following implantation, 1 patients exhibited psychosis (1.5%), 2 patients experienced a clinically relevant worsening of depressive symptoms (3%), 7 patients showed an increase in anxiety (12%) and 3 patients a worsening in depression and anxiety symptoms (3%). On the contrary, 12 patients (20%) showed a relevant improvement in mood and 14 patients (23%) a relevant reduction of anxiety symptoms after the surgery. Conclusions: The present study confirms that STN DBS is cognitively safe since the only relevant change observed was a mild decrease in verbal fluency tasks. Globally, a small postoperative improvement was found in the BDI, and in two SCID-II subscales concerning obsessive-compulsive and paranoid personality traits, even though postoperative behavioural disturbances can occur in individual patients.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 12/1/2005
Accepted: 3/2/2006
Published online: 6/23/2006

Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 6

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: http://www.karger.com/ENE


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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References

  1. Lopiano L, Rizzone M, Bergamasco B, et al: Deep brain stimulation of the subthalamic nucleus: clinical effectiveness and safety. Neurology 2001;56:552–554.
  2. Vingerhoets FJG, Villemure JG, Temperli P, et al: Subthalamic DBS replaces levodopa in Parkinson’s disease: two years follow-up. Neurology 2002;58:396–401.
  3. Krack P, Batir A, Van Blercom N, et al: Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 2003;349:1925–1934.
  4. Woods SP, Fields JA, Tröster AI: Neuropsychological sequelae of subthalamic nucleus deep brain stimulation in Parkinson’s disease: a critical review. Neuropsychol Rev 2002;12:111–126.
  5. Daniele A, Albanese A, Contarino MF, et al: Cognitive and behavioural effects of chronic stimulation of the subthalamic nucleus in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2003;74:175–182.
  6. Gironell A, Kulisevsky J, Rami L, et al: Effects of pallidotomy and bilateral subthalamic stimulation on cognitive function in Parkinson’s disease. A controlled comparative study. J Neurol 2003;250:917–923.
  7. Morrison CE, Borod JC, Perrine K, et al: Neuropsychological functioning following bilateral subthalamic nucleus stimulation in Parkinson’s disease. Arch Clin Neuropsychol 2004;19:165–181.
  8. Funkiewiez A, Ardouin C, Caputo E, et al: Long-term effects of bilateral subthalamic nucleus stimulation on cognitive function, mood, and behaviour in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2004;75:834–839.
  9. Alegret M, Junqué C, Valldeoriola F, et al: Effect of bilateral subthalamic stimulation on cognitive function in Parkinson disease. Arch Neurol 2001;58:1223–1227.
  10. Ardouin C, Pillon B, Peiffer E, et al: Bilateral subthalamic or pallidal stimulation for Parkinson’s disease affect neither memory nor executive functions: a consecutive series of 62 patients. Ann Neurol 1999;46:217–223.
  11. Saint-Cyr JA, Trépanier LL, Kumar R, Lozano AM, Lang AE: Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson’s disease. Brain 2000;123:2091–2108.
  12. Trépanier LL, Kumar R, Lozano AM, Lang AE, Saint-Cyr A: Neuropsychological outcome of GPi pallidotomy and GPi or STN deep brain stimulation in Parkinson’s disease. Brain Cogn 2000;42:324–347.
  13. Dujardin K, Defebvre L, Krystkowiac P, et al: Influence of chronic bilateral stimulation of the subthalamic nucleus on cognitive function in Parkinson’s disease. J Neurol 2001;248:603–611.
  14. Jahanshahi M, Arduin C, Brown RG: The impact of deep brain stimulation on executive function in Parkinson’s disease. Brain 2000;123:1142–1154.
  15. Piacesky SD, Jefferson JW: Psychiatric complications of deep brain stimulation for Parkinson’s disease. J Clin Psychiatry 2004;65:845–849.
  16. Anderson KE, Jake Mullins BA: Behavioural changes associated with deep brain stimulation surgery for Parkinson’s disease. Curr Neurol Neurosci Rep 2003;3:306–313.
  17. Takeshita S, Kurisu K, Trop L, et al: Effect of subthalamic stimulation on mood state in Parkinson’s disease: evaluation of previous facts and problems. Neurosurg Rev 2005;28:179–186.
  18. Berney A, Vingerhoets F, Perrin A, et al: Effect on mood of subthalamic DBS for Parkinson’s disease. Neurology 2002;59:1427–1429.
  19. Thobois S, Mertens P, Guenot M, et al: Subthalamic nucleus stimulation in Parkinson’s disease: clinical evaluation of 18 patients. J Neurol 2002;249:529–534.
  20. Burkhard PR, Vingerhoets FJC, Berney A, et al: Suicide after successful deep brain stimulation for movement disorder. Neurology 2004;63:2170–2172.
  21. Doshi PK, Chhaya N, Bhatt MH: Depression leading to attempted suicide after bilateral subthalamic nucleus stimulation. Mov Disord 2002;17:1084–1085.
  22. Higginson CI, Fields JA, Troster AI: Which symptoms of anxiety diminish after surgical intervention for Parkinson’s disease? Neuropsych Neuropsychol Behav Neurol 2001;14:117–121.
  23. Mallet L, Mesnage V, Houeto JL: Compulsions, Parkinson’s disease, and stimulation. Lancet 2002;360:1302–1304.
  24. Czernecki V, Pillon B, Houeto JL, et al: Does bilateral stimulation of the subthalamic nucleus aggravate apathy in Parkinson’s disease? J Neurol Neurosurg Psychiatry 2005;76:775–779.
  25. Lopiano L, Rizzone M, Bergamasco B, et al: Deep brain stimulation of subthalamic nucleus in PD: an analysis of the exclusion causes. J Neurol Sci 2002;195:167–170.
  26. Lanotte M, Rizzone M, Bergamasco B, et al: Deep brain stimulation of the subthalamic nucleus: anatomical, neurophysiological, and outcome correlations with the effects of stimulation. J Neurol Neurosurg Psychiatry 2002;72:53–58.
  27. Defer GL, Widner H, Marié RM, et al: Core assessment program for surgical interventional therapies in Parkinson’s disease (CAPSIT-PD). Mov Disord 1999;14:572–584.
  28. Lozano AM, Lang AE, Galvez-Jimenez N, et al: Effect of GPi pallidotomy on motor function in Parkinson’s disease. Lancet 1995;346:1383–1387.
  29. Perozzo P, Rizzone M, Bergamasco B, et al: Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: comparison of pre- and post-operative neuropsychological evaluation. J Neurol Sci 2001;192:9–15.
  30. Raven JC: Coloured Progressive Matrices (Sets A, AB, B). London, Lewin HK, 1962.
  31. Spinnler H, Tognoni G: Standardizzazione e taratura italiana di test neuropsicologici. Ital J Neurol Sci 1987;6(suppl 8):1–120.
  32. Wechsler D: A standardized memory scale for clinical use. J Psychol 1945;19:87–95.
  33. Reitan RM: Validity of the Trail Making Test as an indication of organic brain damage. Percept Mot Skill 1958;8:271–276.

    External Resources

  34. Nelson HE: A modified Card Sorting Test sensitive to frontal lobe defect. Cortex 1976;12:313–324.
  35. Benton AL: Differential behavioural effects in frontal lobe disease. Neuropsychology 1968;6:53–60.

    External Resources

  36. Beck AT: Beck Depression Inventory. San Antonio, Psychological Corporation, 1987.
  37. Beck AT: Depression. Philadelphia, University of Pennsylvania Press, 1970.
  38. Spielberger CD, Gorsuch RL, Lushene RE: STAI. Questionario di autovalutazione per l’ansia di stato e di tratto. Firenze, Organizzazioni Speciali, 1980.
  39. Spitzer RL, Williams JBW, Gibbon M, First MB: Questionario SCID II (Italian translation). Firenze, Organizzazioni Speciali, 1993.
  40. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
  41. Schroeder U, Kuehler A, Lange KW, et al: Subthalamic nucleus stimulation affects a frontotemporal network: a PET study. Ann Neurol 2003;54:445–450.
  42. Marsen CD, Obeso JA: The function of the basal ganglia and the paradox of stereotaxic surgery in Parkinson’s disease. Brain 1994;117:877–897.
  43. Burn DJ, Tröster AI: Neuropsychiatric complications of medical and surgical therapies for Parkinson’s disease. J Geriatr Psychiatry Neurol 2004;17:172–180.
  44. Houeto JL, Mesnage V, Mallet L, et al: Behavioral disorders, Parkinson’s disease and subthalamic stimulation. J Neurol Neurosurg Psychiatry 2002;72:701–707.
  45. Albanese A, Piacentini S, Romito LMA, et al: Suicide after successful deep brain stimulation for movement disorder. Neurology 2005;65:499–500.
  46. Medina J: Neural implants and obsessive-compulsive disorder. Psychiatr Times 2003;20:43–46.
  47. George M: New methods of brain stimulation are improving research and therapy in obsessive-compulsive disorder. CNS Spectr 2000;5:12–17.