Influence of bilateral Stn-stimulation on psychiatric symptoms and psychosocial functioning in patients with Parkinson’s disease

Kalteis, Karin; Standhardt, Harald; Kryspin-Exner, Ilse; Brücke, Thomas; Volc, Dieter; Alesch, François

doi:10.1007/s00702-005-0399-9

Cited by 32 publications

(35 citation statements)

References 55 publications

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“…"On" state evaluation was considered in studies reporting "on" versus "off" state comparison. In partial duplicates with patients overlapping but with different assessment scales, 39,53 follow-up time 20,31 or comparison groups, 77 a selection of relevant data was performed for each one, and only specific duplicated information was excluded.…”

Section: Methodsmentioning

confidence: 99%

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

et al. 2014

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RESUMOIntrodução: A estimulação cerebral profunda (ECP) é eficaz na doença de Parkinson (DP) avançada, melhorando sintomas motores, flutuações e a qualidade de vida. No entanto, têm sido reportados efeitos adversos psiquiátricos, mas de uma forma variável e não padronizada. O objectivo deste artigo é analisar e sumarizar a evidência publicada sobre sintomas depressivos e ansiedade em doentes com DP após ECP, através de revisão sistemática e meta-análise. Material e Métodos: A PubMed foi pesquisada até Maio 2012 para identificar os estudos que avaliaram sintomas depressivos e ansiedade em doentes com doença de Parkinson submetidos a estimulação cerebral profunda bilateral do núcleo subtalâmico (NST) ou globo pálido interno (GPi). Foram feitas meta-análises com modelo de efeitos aleatórios para grupos de pelo menos três estudos homogéneos em relação ao desenho e instrumentos utilizados. Resultados: Foram selecionadas 63 referências; 98,4% continham dados relativos a escalas de avaliação de depressão e 38,1% relativos a ansiedade. Dois estudos não discriminavam o alvo usado; nos restantes 61 foi feita avaliação de curto prazo em 37 (60,7%), de médio prazo em 36 (59,0%) e de longo prazo em 5 (8,2%). Foram encontrados dados sobre variação pré/pós operatória em 57 (93,4%) estudos e 16 (26,2%) continham dados comparando ECP-NST versus outros grupos: ECP-GPi (n = 4 estudos, 25,0%), elegíveis para cirurgia (n = 6, 37,5%), e tratamento médico (n = 7, 43,8%). Discussão: É aparente a melhoria de depressão e ansiedade após ECP, sobretudo a curto prazo, efeito que tende a esbater-se em avaliações posteriores. Em relação à depressão a ECP-NST mostrou-se superior ao tratamento médico, mas não em comparação com o grupo de controlo elegível para cirurgia. Verificou-se o resultado oposto para a ansiedade, uma vez que os resultados favorecem o tratamento médico sobre a ECP-NST, e esta sobre o grupo de elegíveis para cirurgia. Não é evidente a superioridade de um alvo sobre o outro, mas os dados favorecem ligeiramente o GPi para ambos os tipos de sintomas. Conclusões:O padrão e curso dos sintomas depressivos e ansiedade após ECP na DP não são claros, mas ambos parecem melhorar no curto prazo, especialmente a depressão após a ECP-NST. Os resultados são bastante heterogéneos. Devem ser promovidos esforços no sentido de haver padronização de procedimentos de avaliação nos vários centros. Palavras-chave: Doença de Parkinson; Estimulação Cerebral Profunda; Ansiedade; Depressão; Meta-Análise. ABSTRACT Introduction: Deep brain stimulation (DBS) is effective in advancedParkinson's disease (PD), improving motor symptoms, fluctuations and quality of life. However, adverse psychiatric outcomes have been reported, albeit variably and in an unstandardized fashion. We aimed to summarize the published evidence on the outcomes of anxiety and depressive symptoms in Parkinson's disease patients following DBS, through systematic review and meta-analysis. Material and Methods: PubMed was searched until May 2012 to identify studies assessing anxiety and...

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Section: Methodsmentioning

confidence: 99%

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

et al. 2014

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“…Deep brain stimulation (DBS) is often used as a late therapeutic option in the treatment of PD when motor symptoms can not be adequately controlled with medication alone [39]. In addition to improving motor function, some studies have also found DBS to be associated with improvements in mood and depression [40,41,42]. The results of these studies are equivocal, however, as some reports have demonstrated adverse reactions, including significant worsening of depressive symptoms and suicidal ideation [41,43,44] and inducement of mania [45,46,47].…”

Section: Depression and Parkinson's Diseasementioning

confidence: 99%

“…It is also important to note that even for patients with depression of a hypothesized neurochemical etiology, addressing the behavioral and cognitive sequale of this phenomenon can prove helpful [40].…”

Section: Use Of Cbt To Target Specific Symptoms Of Dpdmentioning

confidence: 99%

“…Therefore, several different CBT strategies (based on Beck et al, 1979; Lewinsohn et al, 1986) [40,91,92] can be used to help PD patients cope more effectively with the numerous symptoms of depression described above, as well as with the daily stress of living with PD. Examples described below were derived from a past pilot study conducted by our group [28].…”

Section: Use Of Cbt To Target Specific Symptoms Of Dpdmentioning

confidence: 99%

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CBT for the treatment of depression in Parkinson’s disease: a promising nonpharmacological approach

Dobkin¹,

Menza²,

Bienfait³

2008

Expert Review of Neurotherapeutics

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Depression is very common in PD and linked with a faster progression of physical symptoms, greater cognitive decline, and poorer quality of life. Non-pharmacological approaches, like cognitivebehavioral therapy (CBT), for the treatment of depression in Parkinson's disease (dPD) have received little experimental attention despite strong demonstrated efficacy in other geriatric and medical populations. Depressed PD patients often differ from the depressed non-PD elderly in that they present with increased rates of both executive dysfunction and co-morbid psychiatric diagnoses, may differ in their depressive symptom presentation, and typically have caregivers who are highly involved in their treatment. Therefore, it is not possible to conclude that empirically validated treatments in the depressed aged will generalize to those with Parkinson's disease. In order to be most effective for PD patients, CBT should be tailored to their unique needs. Additional controlled research is needed to further explore the efficacy of CBT for dPD.

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“…Several studies using patient-report inventories have reported improvement in depressive symptomatology. 16,38,74,75 Similarly, studies disagree as to whether apathy does or does not increase after STN DBS. 55,76 On the one hand, studies reporting post-operative incidence of behavioural changes typically do not report a change from the pre-operative state, leaving it possible that the incidence of psychiatric conditions actually improves from pre-operative levels.…”

Section: Controversymentioning

confidence: 99%

Effects of Deep Brain Stimulation on Cognition, Mood and Behaviour in Parkinson’s Disease

Tröster¹

2008

European Neurological Review

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32Disappointed by the limitations of pharmacotherapy, emboldened by technological advances in surgery and radiology and armed with a better understanding of pathophysiology, physicians and scientists in the 1980s charted a renaissance of surgery for movement disorders such as Parkinson's disease (PD). The desire for a safer alternative to lesional or ablative neurosurgery, coupled with observations that intraoperative electrical stimulation used for target identification could alleviate abnormal movements, 1,2 prompted the exploration of fully Neurobehavioural Effects of Deep Brain Stimulation in Parkinson's DiseaseBy far the most attention to neurobehavioural outcomes of DBS has been devoted to PD, and the majority of these studies have examined the outcome of subthalamic (STN) rather than thalamic or pallidal (GPi) DBS. Probably greater controversy attends the neurobehavioural outcomes after STN DBS than after GPi or thalamic DBS, and this probably reflects, at least in part, differences among studies in the sample characteristics, selection and exclusion criteria, length of follow-up, surgical technique, post-operative DBS programming and pharmacotherapy protocols, and the thoroughness and timing of the neuropsychological evaluation protocol. In general, studies employing cognitive screening instruments fail to detect neurobehavioural morbidity. While some may argue that the lack of change on screening instruments suggests that neuropsychological changes detected by more extensive evaluations are not of clinical significance, a recent meta-analysis of the empirical data suggests that screening instruments may be insensitive even to clinically meaningful changes after DBS. 8 Consequently, cognitive screening measures are probably useful in helping decide which surgical candidates can be excluded from further evaluation (including full neuropsychological evaluation), but insufficient to adequately document neurobehavioural outcomes of DBS. Thalamic Deep Brain StimulationFour studies 9-12 have observed no widespread or significant changes in cognition, mood or behaviour after unilateral thalamic DBS, although one study suggested that statistically (but not necessarily clinically) significant declines in verbal memory are associated with left thalamic DBS. Few studies have examined mood after thalamic DBS, but one study 9 found an improvement in depressive symptoms four to 10 days after surgery. Pallidal Deep Brain StimulationUnilateral GPi DBS appears cognitively safe, although this conclusion is tempered by the limited number of small-sample studies published. [13][14][15] Although patients in one study showed statistically significant declines in visuoconstructional ability and verbal fluency, the changes were rarely of clinical significance. Even when using a liberal criterion of impairment (a test score falling one standard deviation below the mean of normative samples), another study 13 observed that only six of the 20 patients showed any increase, no matter how small, in the percentage of tests in the imp...

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Influence of bilateral Stn-stimulation on psychiatric symptoms and psychosocial functioning in patients with Parkinson’s disease

Cited by 32 publications

References 55 publications

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

CBT for the treatment of depression in Parkinson’s disease: a promising nonpharmacological approach

Effects of Deep Brain Stimulation on Cognition, Mood and Behaviour in Parkinson’s Disease

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