Structural and functional correlates of subthalamic deep brain stimulation-induced apathy in Parkinson's disease
Structural and functional correlates of subthalamic deep brain stimulation-induced apathy in Parkinson's disease
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DOI：
10.1016/j.brs.2020.12.008
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发表时间：
2021-01-07
影响因子：
7.7
通讯作者：
Berendse, Henk W.
中科院分区：
文献类型：
--
作者：
Boon, Lennard I.;Potters, Wouter V.;Berendse, Henk W.
背景资料：尽管接受脑深部电刺激（DBS）治疗的帕金森病（PD）患者的运动功能有很大改善，但冷漠可能会增加。术后冷漠并不总是与多巴胺能药物的剂量减少和刺激本身可能发挥作用。Objective：We studied whether apathy in DBS-treated PD patients could be a stimulation effects.Methods：在26例PD患者中，我们获得了丘脑底核DBS（DBS）前和DBS后> 6个月的冷漠评分。脑磁图记录（ON和OFF刺激）在DBS放置后>= 6个月进行。情感淡漠严重程度的变化与（i）运动功能改善和多巴胺能药物剂量减少，（ii）刺激位置（合并的MRI和CT扫描）和（iii）在声称在冷漠中起作用的脑区域的功能连接中的刺激相关变化。DBS后平均冷漠严重程度显著增加（p < 0.001），认为冷漠的患者数量从2例增加到9例。情感淡漠严重程度的改变与运动功能的改善或多巴胺能药物剂量的减少无关。对于左半球，冷漠的增加与更多的背外侧刺激位置相关（p = 0.010）。冷漠的严重程度的增加与减少α 1功能连接的背外侧前额叶皮层（p = 0.006），但不与内侧眶额或前扣带回cort.Conclusions的变化：目前的观察表明，冷漠后STN-DBS不一定与多巴胺能药物的剂量减少，但可能是刺激本身的效果。这突出了根据运动和非运动症状确定最佳DBS设置的重要性。(c)2020作者（S）爱思唯尔公司出版
Background: Notwithstanding the large improvement in motor function in Parkinson's disease (PD) patients treated with deep brain stimulation (DBS), apathy may increase. Postoperative apathy cannot always be related to a dose reduction of dopaminergic medication and stimulation itself may play a role.Objective: We studied whether apathy in DBS-treated PD patients could be a stimulation effect.Methods: In 26 PD patients we acquired apathy scores before and > 6 months after DBS of the sub thalamic nucleus (STN). Magnetoencephalography recordings (ON and OFF stimulation) were performed >= 6 months after DBS placement. Change in apathy severity was correlated with (i) improvement in motor function and dose reduction of dopaminergic medication, (ii) stimulation location (merged MRI and CT-scans) and (iii) stimulation-related changes in functional connectivity of brain regions that have an alleged role in apathy.Results: Average apathy severity significantly increased after DBS (p < 0.001) and the number of patients considered apathetic increased from two to nine. Change in apathy severity did not correlate with improvement in motor function or dose reduction of dopaminergic medication. For the left hemisphere, increase in apathy was associated with a more dorsolateral stimulation location (p = 0.010). The increase in apathy severity correlated with a decrease in alpha1 functional connectivity of the dorsolateral prefrontal cortex (p = 0.006), but not with changes of the medial orbitofrontal or the anterior cingulate cortex.Conclusions: The present observations suggest that apathy after STN-DBS is not necessarily related to dose reductions of dopaminergic medication, but may be an effect of the stimulation itself. This highlights the importance of determining optimal DBS settings based on both motor and non-motor symptoms. (c) 2020 The Author(s). Published by Elsevier Inc.