Deep Brain Stimulation of the Subthalamic Nucleus Enhances Emotional Processing in Parkinson Disease

Schneider, Frank; Habel, Ute; Volkmann, Jens; Regel, Sabine J.; Kornischka, Jürgen; Sturm, Volker; Freund, Hans‐Joachim

doi:10.1001/archpsyc.60.3.296

Cited by 139 publications

(91 citation statements)

References 52 publications

(53 reference statements)

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“…STN-DBS itself has a positive eff ect on offperiod apathy, contributing to improvement of off -period cognitive and emotional aspects in apathy. 92,[104][105][106] However, with regard to the on-period motivational aspects of the antiparkinsonian drugs, a slowly progressive desensitisation of the psychotropic eff ects of dopaminergic treatment after drug decrease 107 explains why the hypodopaminergic withdrawal syndrome in patients on chronic STN-DBS typically occurs with a substantial delay of several months after surgery 83,92 (unlike the much more acute withdrawal syndrome after cessation of dopamine agonists in patients not receiving chronic STN-DBS). 93 The potential to reverse postoperative apathy after D2 or D3 receptor stimulation with oral dopamine receptor agonists 108,109 clearly suggests a Parkinson's disease-related symptom that has been unmasked by a decrease in drug treatment.…”

Section: Apathy After Deep Brain Stimulation In Parkinson's Diseasementioning

confidence: 99%

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Pagonabarraga

Kulisevsky

Strafella

et al. 2015

The Lancet Neurology

422

394

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Normal maintenance of human motivation depends on the integrity of subcortical structures that link the prefrontal cortex with the limbic system. Structural and functional disruption of diff erent networks within these circuits alters the maintenance of spontaneous mental activity and the capacity of aff ected individuals to associate emotions with complex stimuli. The clinical manifestations of these changes include a continuum of abnormalities in goal-oriented behaviours known as apathy. Apathy is highly prevalent in Parkinson's disease (and across many neurodegenerative disorders) and can severely aff ect the quality of life of both patients and caregivers. Diff erentiation of apathy from depression, and discrimination of its cognitive, emotional, and auto-activation components could guide an individualised approach to the treatment of symptoms. The opportunity to manipulate dopaminergic treatment in Parkinson's disease allows researchers to study a continuous range of motivational states, from apathy to impulse control disorders. Parkinson's disease can thus be viewed as a model that provides insight into the neural substrates of apathy.

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Section: Apathy After Deep Brain Stimulation In Parkinson's Diseasementioning

confidence: 99%

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Pagonabarraga

Kulisevsky

Strafella

et al. 2015

The Lancet Neurology

422

394

View full text Add to dashboard Cite

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“…However, the vast majority of cases with an acute emotional response to STN DBS exhibit hypomania [50] or mania [25,52]. More importantly, a systematic study of a large number of PD patients revealed a mood effect of acute STN DBS that corresponds to subjective wellbeing or euphoria, and not depression [23,59]. Single case reports have also shown that dysphoria during the off-medication period is improved by STN DBS [60][61][62].…”

Section: The Stn and Impulsivitymentioning

confidence: 99%

Deep brain stimulation: from neurology to psychiatry?

Krack

Hariz

Baunez

et al. 2010

Trends in Neurosciences

268

186

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International audienceFunctional stereotaxy was introduced in the late 1940s to reduce the morbidity of lobotomy in psychiatric disease by using more focal lesions. The advent of neuroleptics led to a drastic decline in psychosurgery for several decades. Functional stereotactic neurosurgery has recently been revitalized, starting with treatment of Parkinson's disease, in which deep brain stimulation (DBS) facilitates reversible focal neuromodulation of altered basal ganglia circuits. DBS is now being extended to treatment of neuropsychiatric conditions such as Gilles de la Tourette syndrome, obsessive-compulsive disorder, depression and addiction. In this review, we discuss the concept that dysfunction of motor, limbic and associative cortico-basal ganglia-thalamocortical loops underlies these various disorders, which might now be amenable to DBS treatment

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“…23,24 Previous studies have used acute effects of STN DBS as a tool to modify the activity in basal ganglia circuits intraindividually. [25][26][27][28][29][30] To evaluate the possible influence of STN stimulation on spatial orientation, we assessed 12 patients with Parkinson's disease (PD) after implantation of electrodes in the STN for chronic DBS in four conditions: turning both stimulators OFF, turning ON only the right stimulator, turning ON only the left stimulator, and turning ON both stimulators. After overnight withdrawal of L-dopa, patients were pseudorandomly assigned to one of the stimulation conditions.…”

mentioning

confidence: 99%

Change in artistic expression related to subthalamic stimulation

Witt¹,

Krack²,

Deuschl³

2006

J Neurol

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While the role of frontal and parietal cortex in spatial orientation has been studied extensively, the contribution of the basal ganglia and especially the subthalamic nucleus to spatial orientation remains less clear. Here we use subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) as a reversible model of functional lesioning to evaluate the influence of the STN in extrapersonal space orientation. To this end, 12 PD patients were examined 1 year after implantation of DBS electrodes in the STN after overnight withdrawal of L-dopa. Patients were tested in a pseudorandomized order while both stimulators, the right only, the left only, or no stimulator, were switched on. Patients performed line bisection and a reaction time task responding to stimuli of the middle, the left, and the right extrapersonal space. A separate assessment of the right and left hand responding to visual stimuli in each hemispace made it possible to distinguish hemispatial and hemimotor impairments. No asymmetries in space orientation were found when both stimulators were switched OFF, when both stimulators were switched ON, and when only the right stimulator was switched ON. When only the left subthalamic stimulation was switched ON, the reaction times of both hands to visual stimuli in the left extrapersonal hemispace increased significantly and the line bisection test showed a significant orientation to the right. These results lead to the conclusion that the STN and its cortical projections influence the network involved in visuospatial orientation. These patterns of symptoms of neglect demonstrate the influence of the STN on the attentional system of the nondominant hemisphere.

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Deep Brain Stimulation of the Subthalamic Nucleus Enhances Emotional Processing in Parkinson Disease

Cited by 139 publications

References 52 publications

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Deep brain stimulation: from neurology to psychiatry?

Change in artistic expression related to subthalamic stimulation

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