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Acute and Chronic Mood and Apathy Outcomes from a randomized study of unilateral STN and GPi DBS.
PLoS One. 2014; 9(12):e114140.Plos

Abstract

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.

Authors+Show Affiliations

Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America; Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.Department of Biostatistics, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.Department of Psychiatry, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.Department of Psychiatry, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America; Department of Clinical and Health Psychology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States of America.Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America.

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25469706

Citation

Okun, Michael S., et al. "Acute and Chronic Mood and Apathy Outcomes From a Randomized Study of Unilateral STN and GPi DBS." PloS One, vol. 9, no. 12, 2014, pp. e114140.
Okun MS, Wu SS, Fayad S, et al. Acute and Chronic Mood and Apathy Outcomes from a randomized study of unilateral STN and GPi DBS. PLoS One. 2014;9(12):e114140.
Okun, M. S., Wu, S. S., Fayad, S., Ward, H., Bowers, D., Rosado, C., Bowen, L., Jacobson, C., Butson, C., & Foote, K. D. (2014). Acute and Chronic Mood and Apathy Outcomes from a randomized study of unilateral STN and GPi DBS. PloS One, 9(12), e114140. https://doi.org/10.1371/journal.pone.0114140
Okun MS, et al. Acute and Chronic Mood and Apathy Outcomes From a Randomized Study of Unilateral STN and GPi DBS. PLoS One. 2014;9(12):e114140. PubMed PMID: 25469706.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute and Chronic Mood and Apathy Outcomes from a randomized study of unilateral STN and GPi DBS. AU - Okun,Michael S, AU - Wu,Samuel S, AU - Fayad,Sarah, AU - Ward,Herbert, AU - Bowers,Dawn, AU - Rosado,Christian, AU - Bowen,Lauren, AU - Jacobson,Charles, AU - Butson,Christopher, AU - Foote,Kelly D, Y1 - 2014/12/03/ PY - 2014/06/20/received PY - 2014/11/03/accepted PY - 2014/12/4/entrez PY - 2014/12/4/pubmed PY - 2015/12/15/medline SP - e114140 EP - e114140 JF - PloS one JO - PLoS One VL - 9 IS - 12 N2 - 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/25469706/Acute_and_Chronic_Mood_and_Apathy_Outcomes_from_a_randomized_study_of_unilateral_STN_and_GPi_DBS_ L2 - https://dx.plos.org/10.1371/journal.pone.0114140 DB - PRIME DP - Unbound Medicine ER -