Acute psychotropic effects of bilateral subthalamic nucleus stimulation and levodopa in Parkinson's disease
Acute psychotropic effects of bilateral subthalamic nucleus stimulation and levodopa in Parkinson's disease
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DOI：
10.1002/mds.10441
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发表时间：
2003-05-01
影响因子：
8.6
通讯作者：
Pollak, P
中科院分区：
文献类型：
--
作者：
Funkiewiez, A;Ardouin, C;Pollak, P
丘脑底核 (STN) 的高频深部脑刺激 (DBS) 可改善帕金森病 (PD) 的运动症状。据报道，手术后会出现相反的情绪变化，例如妈妈或抑郁，但尚不清楚这些副作用是否与 STN DBS 特别相关。为了了解 STN DBS 是否也影响边缘环路，我们研究了与左旋多巴或双侧 STN DBS 相关的急性主观精神作用。术后中位随访时间为 12 个月。 50 名 PD 患者完成了成瘾研究中心量表 (ARCI)，评估主观精神治疗效果：在旅游条件下：停药/刺激；停药/停药累加、开药/停刺激：以及开药/开刺激。左旋多巴和 STN DBS 均改善了所有 ARCI 分量表，表明主观幸福感、欣快感、动力增加以及疲劳、焦虑和紧张的减少。使用与慢性刺激相同的电参数，在 5 个 ARCI 子通道中的 4 个上，阈上剂量的左旋多巴明显比 STN DBS 更有效。我们的结论是：1）STN DBS 和左旋多巴对 PD 具有协同的急性有益精神作用，2）在慢性 STN DBS 的长期治疗中需要考虑两种治疗的精神作用，3）结果表明边缘 STN 参与 PD 情绪障碍。 (C) 2003 年运动障碍协会。
High-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves the motor symptoms of Parkinson's disease (PD). Opposite changes in mood, such as mama or depression, have been reported after surgery, but it is not known whether these side effects acre specifically related to STN DBS. To learn whether STN DBS also influences the limbic loop, we investigated acute subjective psychotropic effects related to levodopa or bilateral STN DBS. After a median postoperative follow-up of 12 months. 50 PD patients completed the Addiction Research Center Inventory (ARCI), assessing subjective psychotropic effect: in tour conditions: off-drug/on-stimulation; off-drug/off-sumulatiom on-drug/off-stimulation: and on-drug/on-stimulation. Both levodopa and STN DBS improved all the ARCI subscales, indicating subjective feelings of well being, euphoria, increase in motivation, and decrease in fatigue, anxiety, and tension. A suprathreshold dose of levodopa was significantly more effective than STN DBS, using the same electrical parameters as for chronic stimulation, on four of the five ARCI subscates. We concluded that 1) both STN DBS and levodopa have synergistic acute beneficial psychotropic effects in PD, 2) the psychotropic effects of both treatments need to be considered in the long-term management of chronic STN DBS, and 3) the results indicate an involvement of the limbic STN in mood disorders of PD. (C) 2003 Movement Disorder Society.