The effect of unilateral subthalamic nucleus deep brain stimulation on depression in Parkinson's disease

Abstract

Background Depression is common in Parkinson’s disease (PD) and adversely affects quality of life. Both unilateral and bilateral subthalamic (STN) deep brain stimulation (DBS) effectively treat the motor symptoms of PD, but questions remain regarding the impact of unilateral STN DBS on non-motor symptoms, such as depression. Methods We report changes in depression, as measured by the Hamilton Depression Rating Scale (HAMD-17), in 50 consecutive PD patients who underwent unilateral STN DBS. Participants were also evaluated with UPDRS part III, Parkinson’s Disease Questionnaire-39, and Pittsburgh Sleep Quality Index. The primary outcome was change in HAMD-17 at 6 months versus pre-operative baseline, using repeated measures analysis of variance (ANOVA). Secondary outcomes included the change in HAMD-17 at 3, 12, 18, and 24 months post-operatively and correlations amongst outcome variables using Pearson correlation coefficients. As a control, we also evaluated changes in HAMD-17 in 25 advanced PD patients who did not undergo DBS. Results Participants with unilateral STN DBS experienced significant improvement in depression 6 months post-operatively (4.94±4.02) compared to preoperative baseline (7.90±4.44) (mean±SD) (p=<0.0001). HAMD-17 scores did not correlate with UPDRS part III at any time-point. Interestingly, the HAMD-17 was significantly correlated with sleep quality and quality of life at baseline, 3 months, and 6 months post-operatively. Participants without DBS experienced no significant change in HAMD-17 over the same interval. Conclusion Unilateral STN DBS improves depression 6 months post-operatively in patients with PD. Improvement in depression is maintained over time and correlates with improvement in sleep quality and quality of life.

Measures of impulsivity in Parkinson's disease decrease after DBS in the setting of stable dopamine therapy

“…[30] It is important to emphasize that the patients in our study underwent unilateral DBS. Our findings align with previously documented changes in ICD symptoms following unilateral DBS of both the STN and GPi [8] and further establish the potential for non-motor effects of unilateral DBS, previously shown to include changes in both mood [31] and cognition[33]. However, it remains unclear how bilateral DBS might have impacted these findings.…”

Loss of Prefrontal Cortical Higher Cognition with Uncontrollable Stress: Molecular Mechanisms, Changes with Age, and Relevance to Treatment

“…This includes projections to hypothalamus and brainstem centers that coordinate the stress response [34], consistent with its activity correlating with increased cortisol release in stressed human subjects (see Table S2 in the Supplement of Reference [35]). BA25 also interconnects with the medial subthalamic nucleus [36], which, if playing a role similar to that in motor circuits, may provide pervasive inhibition relevant to symptoms of “mental paralysis,” a hypothesis supported by the antidepressant effects of subthalamic deep brain stimulation [37].…”

The Dominant-Subthalamic Nucleus Phenomenon in Bilateral Deep Brain Stimulation for Parkinson’s Disease: Evidence from a Gait Analysis Study

“…Even though bilateral STN-DBS is considered a relatively safe procedure, in the last years there has been a growing interest in unilateral and staged STN-DBS (i.e., implant of the two electrodes during two distinct surgical sittings separated over time), which involves lower surgical risk and less post-operative complications, such as cognitive dysfunctions ( 11 – 14 ). Alberts et al ( 13 ), for example, showed a decline in cognitive and motor functions when patients were examined under dual-task conditions only with bilateral but not with unilateral STN-DBS.…”