Acute and Chronic Mood and Apathy Outcomes from a Randomized Study of Unilateral STN and GPi DBS
| Autor: | Dawn Bowers, Lauren N. Bowen, Charles E. Jacobson, Christian A Rosado, Samuel S. Wu, Kelly D. Foote, Michael S. Okun, Sarah M. Fayad, Herbert E. Ward, Christopher R. Butson |
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| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_treatment Deep Brain Stimulation lcsh:Medicine Cohort Studies 0302 clinical medicine Medicine and Health Sciences Medicine Apathy lcsh:Science Multidisciplinary Parkinson Disease Middle Aged 3. Good health Subthalamic nucleus surgical procedures operative Treatment Outcome Neurology Acute Disease Female medicine.symptom therapeutics medicine.drug Research Article Biotechnology medicine.medical_specialty Levodopa Deep brain stimulation Surgical and Invasive Medical Procedures Young Mania Rating Scale Globus Pallidus 03 medical and health sciences Physical medicine and rehabilitation Rating scale Subthalamic Nucleus Humans Psychiatry Aged Psychiatric Status Rating Scales business.industry Mood Disorders lcsh:R Biology and Life Sciences medicine.disease 030227 psychiatry nervous system diseases Mood Mood disorders nervous system Chronic Disease lcsh:Q Medical Devices and Equipment business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | PLoS ONE PLoS ONE, Vol 9, Iss 12, p e114140 (2014) |
| ISSN: | 1932-6203 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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