Abstract
Objective: Anxiety and depression are prominent non-motor symptoms of Parkinson’s disease (PD), but their pathophysiology remains unclear. We sought to understand their neurophysiological correlates from chronic invasive recordings of the prefrontal cortex (PFC).Methods: We studied four patients undergoing deep brain stimulation (DBS) for their motor signs, who had comorbid mild to moderate anxiety and/or depressive symptoms. In addition to their basal ganglia leads, we placed a permanent prefrontal subdural 4-contact lead. These electrodes were attached to an investigational pulse generator with the capability to sense and store field potential signals, as well as deliver therapeutic neurostimulation. At regular intervals over 3–5 months, participants paired brief invasive neural recordings with self-ratings of symptoms related to depression and anxiety.Results: Mean age was 61 ± 7 years, mean disease duration was 11 ± 8 years and a mean Unified Parkinson’s Disease Rating Scale, with part III (UPDRS-III) off medication score of 37 ± 13. Mean Beck Depression Inventory (BDI) score was 14 ± 5 and Beck Anxiety Index was 16.5 ± 5. Prefrontal cortex spectral power in the beta band correlated with patient self-ratings of symptoms of depression and anxiety, with r-values between 0.31 and 0.48. Mood scores showed negative correlation with beta spectral power in lateral locations, and positive correlation with beta spectral power in a mesial recording location, consistent with the dichotomous organization of reward networks in PFC.Interpretation: These findings suggest a physiological basis for anxiety and depression in PD, which may be useful in the development of neurostimulation paradigms for these non-motor disease features.
Highlights
Anxiety and depression are prominent non-motor symptoms of Parkinson’s disease (PD) that are clinically debilitating (Seppi et al, 2019) and may predate the onset of motor signs (Postuma et al, 2015)
Interpretation: These findings suggest a physiological basis for anxiety and depression in PD, which may be useful in the development of neurostimulation paradigms for these non-motor disease features
Much progress has been made in understanding circuit mechanisms related to motor signs of PD utilizing invasive intracranial recording at both cortical (Panov et al, 2017) and subcortical (Brittain and Brown, 2014) sites in the motor network
Summary
Anxiety and depression are prominent non-motor symptoms of Parkinson’s disease (PD) that are clinically debilitating (Seppi et al, 2019) and may predate the onset of motor signs (Postuma et al, 2015). Much progress has been made in understanding circuit mechanisms related to motor signs of PD utilizing invasive intracranial recording at both cortical (Panov et al, 2017) and subcortical (Brittain and Brown, 2014) sites in the motor network This technique offers much higher spatiotemporal resolution and a more favorable signal-to-noise ratio than most non-invasive methods, and has led to the identification of potential electrophysiological markers for both the severity of motor signs and for the effectiveness of therapeutic intervention (Brittain and Brown, 2014). Most invasive human physiological studies have been done perioperatively, using externalized brain leads either during a surgical intervention or for a few days after implantation, in a hospital setting This method precludes the study of dynamically evolving longitudinal symptoms. Despite the minimal risk and wide spatial sampling of non-invasive methods such as scalp electroencephalography and functional magnetic resonance imaging, these non-invasive methods are not suited to performing repeated measures in a patient’s home environment
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