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.
Highlights
Neuropsychiatric symptoms in Parkinson’s disease (PD) represent a common, disabling, occasionally socially disruptive condition; they are difficult to treat and have a major impact on quality of life [1, 2]
In this study, combined subthalamic nucleus (STN)+substantia nigra pars reticulata (SNr) stimulation was noninferior compared to STN stimulation in terms of neuropsychiatric symptoms assessed in this study in PD patients
There were no significant differences between these two stimulation conditions in terms of mean scores of apathy, fatigue, depression, impulse control disorder, and quality of life, individual cases profited from the combined stimulation mode in terms of apathy
Summary
Neuropsychiatric symptoms in Parkinson’s disease (PD) represent a common, disabling, occasionally socially disruptive condition; they are difficult to treat and have a major impact on quality of life [1, 2]. Emotional neuropsychiatric symptoms represent a spectrum of various phenomena including apathy, fatigue, and depression on the one hand and impulse control disorder and mania on the other hand [1, 3]. Of particular importance is the relation of neuropsychiatric symptoms to the disease itself, as in the case of apathy and depression, and the relation to the antiparkinsonian treatment observed for impulse control disorder [1, 4]. Fatigue, and depression are common and disabling symptoms preceding the onset of motor symptoms by several years [5]. The noradrenergic LC moved into the focus of interest, since the LC is interconnected
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
