0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

REGULAR ARTICLES   |    
Pallidal Stimulation in Parkinson’s Disease Does Not Induce Apathy
Clément Lozachmeur, M.D.; Sophie Drapier, M.D.; Gabriel Robert, M.D., Ph.D.; Thibaut Dondaine; Bruno Laviolle, M.D., Ph.D.; Paul Sauleau, M.D.; Julie Peron, Ph.D.; Florence Le Jeune, M.D., Ph.D.; David Travers, M.D.; Bruno Millet, M.D., Ph.D.; Marc Vérin, M.D., Ph.D.; Dominique Drapier, M.D., Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:221-226. doi:10.1176/appi.neuropsych.13020032
View Author and Article Information

The authors report no financial relationships with commercial interests.

From the Dept. of Psychiatry, Centre Hospitalier Guillaume Régnier, Rennes, France (CL, GR, TD, DD); “Behavior and Basal Ganglia” Host Team (Equipe d’Accueil), University of Rennes ,Rennes, France (CL, SD,GR, TD, PS, JP, FLJ, DT, BM, MV, DD); Dept. of Neurology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France (SD, TD, JP, MV); Dept. of Psychiatry, Centre Hospitalier Universitaire Pontchaillou, Rennes, France (DT, BM; CHU Rennes, Dept. of Clinical Pharmacology, Centre Hospitalier Universitaire Pontchaillou Rennes, France (BL); INSERM, 0203, Clinical Research Center, Centre Hospitalier Universitaire Pontchaillou, Rennes, France (BL); Dept. of Neurophysiology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France (PS); and Dept. of Nuclear Medicine, Eugene Marquis Center, Rennes, France (FLJ).

Send correspondence to Dr. Lozachmeur; e-mail: c.lozachmeur@ch-guillaumeregnier.fr

Copyright © 2014 by the American Psychiatric Association

Received February 21, 2013; Revised May 07, 2013; Accepted May 08, 2014.

Abstract

Background: Whereas apathy is known as a common consequence of subthalamic nucleus deep brain stimulation in Parkinson’s disease, few studies have investigated the psychiatric consequences of internal globus pallidus deep brain stimulation.

Method: Twenty consecutive parkinsonian patients who underwent bilateral pallidal stimulation were assessed 3 months prior to surgery (M‒3) and at both 3 (M3) and 6 months (M6) after surgery, using psychiatric, neuropsychological, and motor scales. Apathy, mood state, and anxiety state were scored using the Apathy Evaluation Scale, the Montgomery-Åsberg Depression Rating Scale, and the anxiety scale from the Association for Methodology and Documentation in Psychiatry, respectively.

Results: The mean apathy score remained stable between the preoperative M‒3 assessment (37.2±6.2) and both the postoperative M3 (36.9±7.5) and M6 (37.2±5.0) assessments. The mean depression score did not differ between the M‒3 assessment and M3 and M6 assessments. There was no difference between the preoperative mean anxiety score and both the postoperative M3 and M6 scores. The mean score for the Mattis Dementia Rating Scale remained stable at each study visit.

Conclusions: The main result of this study is the absence of deterioration in psychiatric and cognitive scores 3 months and 6 months after pallidal stimulation.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Anchor for Jump
TABLE 1.Psychiatric Rating Scales, 3 Months Before Surgery and 3 and 6 Months After Surgery in GPi-Stimulated Patients
Table Footer Note

AES: Apathy Evaluation Scale; AMDP-AT: Association for Methodology and Documentation In Psychiatry-Anxiety; DBS: deep brain stimulation; GPi: internal globus pallidus; MADRS: Montgomery-Åsberg Depression Rating Scale.

Table Footer Note

p values calculated by Friedman test.

Anchor for Jump
TABLE 2.Neuropsychological Characteristics of Patients, 3 Months Before Surgery and 3 and 6 Months After Surgery in GPi-Stimulated Patients
Table Footer Note

Neuropsychological data are presented as raw scores.

Table Footer Note

DBS: deep brain stimulation; GPi: internal globus pallidus; MDRS: Mattis Dementia Rating Scale; TMT (B-A): difference between the time scores of part B and part A of the Trail Making Test (seconds); WCST: Wisconsin Card Sorting Test.

Table Footer Note

Stroop test: Interference index.

Table Footer Note

p values calculated by Friedman test.

Anchor for Jump
TABLE 3.Motor Scores and Levodopa-Equivalent Daily Dose Before and After Surgery in Gpi-Stimulated Patients
Table Footer Note

GPi: internal globus pallidus; LED: L-dopa equivalent dose (mg/24 h); UPDRS: United PD Rating Scale.

Table Footer Note

p values calculated two-tailed Wilcoxon test.

Table Footer Note

aM+3 versus M+6, p=0.005.

Table Footer Note

bM–3 versus M+6, p=0.003.

Table Footer Note

cM+3 versus M+6, p=0.003.

Table Footer Note

dM–3 versus M+6, p=0.005.

Table Footer Note

eM–3 versus M+3, p=0.0005.

Table Footer Note

fM–3 versus M+6, p=0.004.

Table Footer Note

gM–3 versus M+6, p=0.006.

Table Footer Note

hp=0.94 (Friedman test).

+

References

Limousin  P;  Krack  P;  Pollak  P  et al:  Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease.  N Engl J Med 1998; 339:1105–1111
[CrossRef] | [PubMed]
 
Kumar  R;  Lozano  AM;  Kim  YJ  et al:  Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson’s disease.  Neurology 1998; 51:850–855
[CrossRef] | [PubMed]
 
Durif  F;  Lemaire  JJ;  Debilly  B  et al:  Long-term follow-up of globus pallidus chronic stimulation in advanced Parkinson’s disease.  Mov Disord 2002; 17:803–807
[CrossRef] | [PubMed]
 
Loher  TJ;  Burgunder  JM;  Pohle  T  et al:  Long-term pallidal deep brain stimulation in patients with advanced Parkinson disease: 1-year follow-up study.  J Neurosurg 2002; 96:844–853
[CrossRef] | [PubMed]
 
Volkmann  J;  Allert  N;  Voges  J  et al:  Long-term results of bilateral pallidal stimulation in Parkinson’s disease.  Ann Neurol 2004; 55:871–875
[CrossRef] | [PubMed]
 
Krack  P;  Pollak  P;  Limousin  P  et al:  Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson’s disease.  Brain 1998; 121:451–457
[CrossRef] | [PubMed]
 
Burchiel  KJ;  Anderson  VC;  Favre  J  et al:  Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson’s disease: results of a randomized, blinded pilot study.  Neurosurgery 1999; 45:1375–1382, discussion 1382–1384
[CrossRef] | [PubMed]
 
Krause  M;  Fogel  W;  Heck  A  et al:  Deep brain stimulation for the treatment of Parkinson’s disease: subthalamic nucleus versus globus pallidus internus.  J Neurol Neurosurg Psychiatry 2001; 70:464–470
[CrossRef] | [PubMed]
 
Volkmann  J;  Allert  N;  Voges  J  et al:  Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD.  Neurology 2001; 56:548–551
[CrossRef] | [PubMed]
 
Katayama  Y;  Kasai  M;  Oshima  H  et al:  Double blinded evaluation of the effects of pallidal and subthalamic nucleus stimulation on daytime activity in advanced Parkinson’s disease.  Parkinsonism Relat Disord 2000; 7:35–40
[CrossRef] | [PubMed]
 
Allert  N;  Volkmann  J;  Dotse  S  et al:  Effects of bilateral pallidal or subthalamic stimulation on gait in advanced Parkinson’s disease.  Mov Disord 2001; 16:1076–1085
[CrossRef] | [PubMed]
 
Funkiewiez  A;  Ardouin  C;  Caputo  E  et al:  Long term effects of bilateral subthalamic nucleus stimulation on cognitive function, mood, and behaviour in Parkinson’s disease.  J Neurol Neurosurg Psychiatry 2004; 75:834–839
[CrossRef] | [PubMed]
 
Drapier  D;  Drapier  S;  Sauleau  P  et al:  Does subthalamic nucleus stimulation induce apathy in Parkinson’s disease? J Neurol 2006; 253:1083–1091
[CrossRef] | [PubMed]
 
Marin  RS:  Apathy: a neuropsychiatric syndrome.  J Neuropsychiatry Clin Neurosci 1991; 3:243–254[Review]
[PubMed]
 
Alexander  GE;  Crutcher  MD;  DeLong  MR:  Basal ganglia-thalamocortical circuits: parallel substrates for motor, oculomotor, “prefrontal” and “limbic” functions.  Prog Brain Res 1990; 85:119–146
[PubMed]
 
Parent  A;  Hazrati  LN:  Functional anatomy of the basal ganglia. II. The place of subthalamic nucleus and external pallidum in basal ganglia circuitry.  Brain Res Brain Res Rev 1995; 20:128–154[Review]
[CrossRef] | [PubMed]
 
Rouaud  T;  Dondaine  T;  Drapier  S  et al:  Pallidal stimulation in advanced Parkinson’s patients with contraindications for subthalamic stimulation.  Mov Disord 2010; 25:1839–1846
[CrossRef] | [PubMed]
 
Hälbig  TD;  Gruber  D;  Kopp  UA  et al:  Pallidal stimulation in dystonia: effects on cognition, mood, and quality of life.  J Neurol Neurosurg Psychiatry 2005; 76:1713–1716
[CrossRef] | [PubMed]
 
Okun  MS;  Fernandez  HH;  Wu  SS  et al:  Cognition and mood in Parkinson’s disease in subthalamic nucleus versus globus pallidus interna deep brain stimulation: the COMPARE trial.  Ann Neurol 2009; 65:586–595
[CrossRef] | [PubMed]
 
Anderson  VC;  Burchiel  KJ;  Hogarth  P  et al:  Pallidal vs subthalamic nucleus deep brain stimulation in Parkinson disease.  Arch Neurol 2005; 62:554–560
[CrossRef] | [PubMed]
 
Kirsch-Darrow  L;  Zahodne  LB;  Marsiske  M  et al:  The trajectory of apathy after deep brain stimulation: from pre-surgery to 6 months post-surgery in Parkinson’s disease.  Parkinsonism Relat Disord 2011; 17:182–188
[CrossRef] | [PubMed]
 
Gibb  WRG;  Lees  AJ:  The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease.  J Neurol Neurosurg Psychiatry 1988; 51:745–752
[CrossRef] | [PubMed]
 
Marin  RS;  Biedrzycki  RC;  Firinciogullari  S:  Reliability and validity of the Apathy Evaluation Scale.  Psychiatry Res 1991; 38:143–162
[CrossRef] | [PubMed]
 
Leentjens  AF;  Dujardin  K;  Marsh  L  et al:  Apathy and anhedonia rating scales in Parkinson’s disease: critique and recommendations.  Mov Disord 2008; 23:2004–2014
[CrossRef] | [PubMed]
 
Montgomery  SA;  Asberg  M:  A new depression scale designed to be sensitive to change.  Br J Psychiatry 1979; 134:382–389
[CrossRef] | [PubMed]
 
Bobon  D:  [Contribution of the AMDP scale to quantitative psychopathology].  Acta Psychiatr Belg 1985; 85:5–249
[PubMed]
 
Mattis  S:  Dementia Rating Scale .  Odessa, FL,  Psychological Assessment Resources Inc, 1988
 
Nelson  HE:  A modified card sorting test sensitive to frontal lobe defects.  Cortex 1976; 12:313–324
[CrossRef] | [PubMed]
 
Reitan  RM:  Validity of the Trail Making Test as an indicator of organic brain damage.  Percept Mot Skills 1958; 8:271–276
[CrossRef]
 
Cardebat  D;  Doyon  B;  Puel  M  et al:  [Formal and semantic lexical evocation in normal subjects. Performance and dynamics of production as a function of sex, age and educational level].  Acta Neurol Belg 1990; 90:207–217
[PubMed]
 
Stroop  JR:  Studies of interference in serial verbal reactions.  J Exp Psychol 1953; 18:643–662
[CrossRef]
 
Langston  JW;  Widner  H;  Goetz  CG  et al:  Core assessment program for intracerebral transplantations (CAPIT).  Mov Disord 1992; 7:2–13
[CrossRef] | [PubMed]
 
Fahn  S;  Elton  RL; Members of UPDRS Development Committee:  Unified Parkinson's Disease Rating Scale, in Recent Developments in Parkinson's Disease, vol 2. Edited by Fahn S, Marsden CD, Calne DB. London, Macmillan Health Care Information, Florham Park Macmillan, 1987; pp 153–163
 
Hoehn  MM;  Yahr  MD:  Parkinsonism: onset, progression and mortality.  Neurology 1967; 17:427–442
[CrossRef] | [PubMed]
 
Deuschl  G;  Schade-Brittinger  C;  Krack  P  et al; German Parkinson Study Group, Neurostimulation Section:  A randomized trial of deep-brain stimulation for Parkinson’s disease.  N Engl J Med 2006; 355:896–908
[CrossRef] | [PubMed]
 
Laitinen  LV;  Bergenheim  AT;  Hariz  MI:  Leksell’s posteroventral pallidotomy in the treatment of Parkinson’s disease.  J Neurosurg 1992; 76:53–61
[CrossRef] | [PubMed]
 
Czernecki  V;  Schüpbach  M;  Yaici  S  et al:  Apathy following subthalamic stimulation in Parkinson disease: a dopamine responsive symptom.  Mov Disord 2008; 23:964–969
[CrossRef] | [PubMed]
 
Denheyer  M;  Kiss  ZH;  Haffenden  AM:  Behavioral effects of subthalamic deep brain stimulation in Parkinson’s disease.  Neuropsychologia 2009; 47:3203–3209
[CrossRef] | [PubMed]
 
Thobois  S;  Ardouin  C;  Lhommée  E  et al:  Non-motor dopamine withdrawal syndrome after surgery for Parkinson’s disease: predictors and underlying mesolimbic denervation.  Brain 2010; 133:1111–1127
[CrossRef] | [PubMed]
 
Porat  O;  Cohen  OS;  Schwartz  R  et al:  Association of preoperative symptom profile with psychiatric symptoms following subthalamic nucleus stimulation in patients with Parkinson’s disease.  J Neuropsychiatry Clin Neurosci 2009; 21:398–405
[CrossRef] | [PubMed]
 
Castelli  L;  Lanotte  M;  Zibetti  M  et al:  Apathy and verbal fluency in STN-stimulated PD patients. An observational follow-up study.  J Neurol 2007; 254:1238–1243
[CrossRef] | [PubMed]
 
Sudhyadhom  A;  Bova  FJ;  Foote  KD  et al:  Limbic, associative, and motor territories within the targets for deep brain stimulation: potential clinical implications.  Curr Neurol Neurosci Rep 2007; 7:278–289
[CrossRef] | [PubMed]
 
Yelnik  J:  Functional anatomy of the basal ganglia.  Mov Disord 2002; 17(Suppl 3):S15–S21
[CrossRef] | [PubMed]
 
Le Jeune  F;  Drapier  D;  Bourguignon  A  et al:  Subthalamic nucleus stimulation in Parkinson disease induces apathy: a PET study.  Neurology 2009; 73:1746–1751
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 18.  >
DSM-5™ Clinical Cases > Chapter 17.  >
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 18.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 14.  >
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 18.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>