Eisenstein Sarah A, Dewispelaere William B, Campbell Meghan C, Lugar Heather M, Perlmutter Joel S, Black Kevin J, Hershey Tamara
Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA.
College of Arts and Sciences, Washington University in St. Louis, St. Louis, MO, USA.
Brain Stimul. 2014 Sep-Oct;7(5):701-8. doi: 10.1016/j.brs.2014.06.002. Epub 2014 Jun 12.
Deep brain stimulation of the subthalamic nucleus (STN DBS) reduces Parkinson disease (PD) motor symptoms but has unexplained, variable effects on mood.
The study tested the hypothesis that pre-existing mood and/or anxiety disorders or increased symptom severity negatively affects mood response to STN DBS.
Thirty-eight PD participants with bilateral STN DBS and on PD medications were interviewed with Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) and completed Beck Depression Inventory (BDI) and Spielberger State Anxiety Inventory (SSAI) self-reports. Subsequently, during OFF and optimal ON (clinical settings) STN DBS conditions and while off PD medications, motor function was assessed with the United Parkinson Disease Rating Scale (UPDRS, part III), and participants rated their mood with Visual Analogue Scales (VAS), and again completed SSAI. VAS mood variables included anxiety, apathy, valence and emotional arousal.
STN DBS improved UPDRS scores and mood. Unexpectedly, PD participants diagnosed with current anxiety or mood disorders experienced greater STN DBS-induced improvement in mood than those diagnosed with remitted disorders or who were deemed as having never met threshold criteria for diagnosis. BDI and SSAI scores did not modulate mood response to STN DBS, indicating that clinical categorical diagnosis better differentiates mood response to STN DBS than self-rated symptom severity. SCID diagnosis, BDI and SSAI scores did not modulate motor response to STN DBS.
PD participants diagnosed with current mood or anxiety disorders are more sensitive to STN DBS-induced effects on mood, possibly indicating altered basal ganglia circuitry in this group.
丘脑底核深部脑刺激（STN DBS）可减轻帕金森病（PD）的运动症状，但对情绪的影响却无法解释且存在差异。
本研究检验了以下假设，即既往存在的情绪和/或焦虑障碍或症状严重程度增加会对STN DBS的情绪反应产生负面影响。
对38名接受双侧STN DBS且正在服用PD药物的PD患者进行了《精神疾病诊断与统计手册》第四版修订版轴I障碍结构化临床访谈（SCID），并完成了贝克抑郁量表（BDI）和斯皮尔伯格状态焦虑量表（SSAI）的自我报告。随后，在关期和最佳开期（临床状态）的STN DBS条件下且停用PD药物时，使用统一帕金森病评定量表（UPDRS，第三部分）评估运动功能，患者使用视觉模拟量表（VAS）对自己的情绪进行评分，并再次完成SSAI。VAS情绪变量包括焦虑、冷漠、效价和情绪唤醒。
STN DBS改善了UPDRS评分和情绪。出乎意料的是，被诊断为当前存在焦虑或情绪障碍的PD患者在STN DBS治疗后情绪改善程度大于被诊断为缓解期障碍或被认为从未达到诊断阈值标准的患者。BDI和SSAI评分并未调节对STN DBS的情绪反应，这表明临床分类诊断比自我评定的症状严重程度更能区分对STN DBS的情绪反应。SCID诊断、BDI和SSAI评分并未调节对STN DBS的运动反应。
被诊断为当前存在情绪或焦虑障碍的PD患者对STN DBS引起的情绪影响更为敏感，这可能表明该组患者的基底神经节回路发生了改变。
