Abstract
Bilateral deep brain stimulation of subthalamic nucleus (STN-DBS) has proven effective in improving motor symptoms in Parkinson's disease (PD) patients. However, psychiatric changes after surgery are controversial. In this study, we specifically analyzed apathy following bilateral STN-DBS in PD patients using a meta-analysis. Relevant articles utilized for this study were obtained through literature search on PubMed, ScienceDirect, and Embase databases. The articles included were those contained both pre- and postsurgery apathy data acquired using the Starkstein Apathy Scale or Apathy Evaluation Scale with patient follow-up of at least three months. A total of 9 out of 86 articles were included in our study through this strict screening process. Standardized mean difference (SMD), that is, Cohen's d, with a 95% confidence interval (CI) was calculated to show the change. We found a significant difference between the presurgery stage and the postsurgery stage scores (SMD = 0.35, 95% CI: 0.17∼0.52, P < 0.001). STN-DBS seems to relatively worsen the condition of apathy, which may result from both the surgery target (subthalamic nucleus) and the reduction of dopaminergic medication. Further studies should focus on the exact mechanisms of possible postoperative apathy in the future.
Highlights
Parkinson’s disease (PD) is the second most common neurodegenerative disease after Alzheimer’s disease and is characterized by bradykinesia, rigidity, resting tremors, and postural instability [1]
Based on the comparison of preoperative and postoperative change, we found that there was a significant difference in the score between the presurgery stage and the postsurgery stage (SMD 0.35, 95% confidence interval (CI): 0.17∼0.52, P < 0.001) (Figure 2)
STN-deep brain stimulation (DBS) involves the application of electrical stimuli, with specific pulse amplitude, duration, and frequency to produce a functional lesion within the subthalamic nucleus [29]
Summary
Parkinson’s disease (PD) is the second most common neurodegenerative disease after Alzheimer’s disease and is characterized by bradykinesia, rigidity, resting tremors, and postural instability [1]. In addition to these motor symptoms, PD patients suffer from many nonmotor symptoms including mood and behavior disorders, cognitive changes, autonomic system-failure, sensory symptoms, and sleep disturbances [2,3,4]. It has been well established that bilateral deep brain stimulation of subthalamic nucleus (STN-DBS) significantly improves the primary motor symptoms as well as some nonmotor symptoms, such as sensory symptoms and sleep disturbances [7, 8]. Parkinson’s Disease family. erefore, we performed this quantitative metaanalysis with strict inclusion criteria to study the effect of bilateral STN-DBS on apathy and expected to draw a conclusion and provide useful reference for clinical practice
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