Movement Disorder Unit, Pavillon de Neurologie, CHU Grenoble, Joseph Fourier University, Cedex 9, Grenoble 38043, France.
J Neurol Neurosurg Psychiatry. 2013 Jan;84(1):18-22. doi: 10.1136/jnnp-2012-302444. Epub 2012 Sep 18.
Levodopa therapy in Parkinson's disease (PD) is associated with non-motor complications resulting from sensitisation of the ventral striatum system. Recent studies showed an improvement in non-motor complications in PD patients with subthalamic stimulation. We hypothesised that ventral striatum desensitisation might contribute to this improvement.
Psychostimulant effects of levodopa were prospectively assessed in 36 PD patients with an acute levodopa challenge, before and 1 year after chronic subthalamic stimulation, using the Addiction Research Centre Inventory euphoria subscale. Postoperative evaluation was performed with the same dose of levodopa used in the preoperative assessment and after switching off stimulation. Preoperative and postoperative non-motor fluctuations in everyday life were investigated with the Ardouin Scale. Furthermore, in order to artificially reproduce non-motor fluctuations, a levodopa challenge keeping subthalamic stimulation on was performed to assess depression, anxiety and motivation before and after surgery under the different medication conditions.
After 1 year of chronic subthalamic stimulation with 60.3% reduction in dopaminergic medication, the acute psychostimulant effects of levodopa were significantly reduced compared with preoperatively, as measured by the euphoria subscale (7.22 ± 4.75 vs 4.75 ± 5.68; p = 0.0110). On chronic subthalamic stimulation and with markedly reduced dopaminergic medication, non-motor fluctuations were significantly improved. While off medication/on stimulation scores of depression and anxiety were improved, in the on medication/on stimulation condition the motivation score worsened.
Acute psychostimulant effects of levodopa (off stimulation) were significantly reduced 1 year after surgery. These findings are likely due to desensitisation of the ventral striatum, allowed by the reduction of dopaminergic treatment, and the replacement of pulsatile treatment with continuous subthalamic stimulation.
左旋多巴治疗帕金森病（PD）会引起与腹侧纹状体系统敏化相关的非运动并发症。最近的研究表明，丘脑底核刺激可改善 PD 患者的非运动并发症。我们假设腹侧纹状体脱敏可能是这种改善的原因。
使用成瘾研究中心清单兴奋分量表，前瞻性评估 36 例 PD 患者在接受慢性丘脑底核刺激前后的急性左旋多巴挑战的精神刺激作用。术后评估使用术前评估和刺激关闭后使用的相同左旋多巴剂量进行。使用 Ardouin 量表评估日常生活中的非运动波动。此外，为了人工重现非运动波动，在保持丘脑底核刺激的情况下进行左旋多巴挑战，以评估手术前后在不同药物条件下的抑郁、焦虑和动机。
在慢性丘脑底核刺激 60.3%减少多巴胺能药物治疗后 1 年，与术前相比，急性左旋多巴的精神刺激作用明显降低，通过兴奋分量表（7.22 ± 4.75 对 4.75 ± 5.68；p = 0.0110）。在慢性丘脑底核刺激和明显减少多巴胺能药物治疗的情况下，非运动波动显著改善。虽然停药/刺激时的抑郁和焦虑评分得到改善，但在药物/刺激时的情况下，动机评分恶化。
术后 1 年，左旋多巴的急性精神刺激作用（无刺激）明显降低。这些发现可能是由于腹侧纹状体脱敏所致，这得益于多巴胺能治疗的减少，以及脉冲治疗被连续丘脑底核刺激所取代。
