Aiello Marilena, Eleopra Roberto, Foroni Francesco, Rinaldo Sara, Rumiati Raffaella I
Area of Neuroscience, SISSA, Trieste, TS, Italy.
S.O.C. Neurologia, Azienda Ospedaliero Universitaria "Santa Maria Della Misericordia", Piazzale Santa Maria Della Misericordia, Udine, UD, Italy.
Cortex. 2017 Jul;92:150-161. doi: 10.1016/j.cortex.2017.04.005. Epub 2017 Apr 21.
Weight gain has been reported after deep brain stimulation of the subthalamic nucleus (STN-DBS), a widely used treatment for Parkinson's disease (PD). This nucleus has been repeatedly found to be linked both to reward and to inhibitory control, two key aspects in the control of food intake. In this study, we assessed whether weight gain experienced by patients with PD after STN-DBS, might be due to an alteration of reward and inhibitory functions. Eighteen patients with PD were compared to eighteen healthy controls and tested three times: before surgery, in ON medication and after surgery, respectively five days after the implantation in ON medication/OFF stimulation and at least three months after surgery in ON medication/ON stimulation. All participants were assessed for depression (Beck Depression Inventory), anhedonia (Snaith-Hamilton Pleasure Scale) and impulsiveness (Barratt Impulsiveness Scale). They performed a battery of tests assessing food reward sensitivity (Liking, Wanting and Preference) and a food go/no-go task. Results showed that body weight significantly increased after STN-DBS. A few days after surgery, patients were slower and more impulsive in the go/no-go task, showed a higher preference for high calorie (HC) foods and rated foods as less tasty. Months after subthalamic stimulation, the performance on the go/no-go task improved while no differences were observed in reward sensitivity. Interestingly, weight gain resulted greater in patients with higher levels of attentional impulsiveness pre-surgery, higher wanting for low calorie (LC) foods and impulsivity in the go/no-go task in ON medication/ON stimulation. However, only wanting and attentional impulsivity significantly predicted weight change. Furthermore, weight gain resulted associated with the reduction of l-Dopa after surgery and disease's duration. In conclusion, our findings are consistent with the view that weight gain in PD after STN-DBS has a multifactorial nature, which reflects the complex functional organization of the STN.
据报道，丘脑底核深部脑刺激（STN-DBS）后体重会增加，这是一种广泛用于治疗帕金森病（PD）的方法。该核团反复被发现与奖赏和抑制控制有关，这是控制食物摄入的两个关键方面。在本研究中，我们评估了帕金森病患者在接受STN-DBS后体重增加是否可能是由于奖赏和抑制功能的改变。将18名帕金森病患者与18名健康对照者进行比较，并进行三次测试：手术前、服药状态良好时以及手术后，分别在植入后五天处于服药状态良好/刺激关闭时，以及手术后至少三个月处于服药状态良好/刺激开启时。对所有参与者进行抑郁（贝克抑郁量表）、快感缺失（斯奈斯-汉密尔顿愉悦量表）和冲动性（巴拉特冲动量表）评估。他们进行了一系列测试，评估食物奖赏敏感性（喜好、渴望和偏好）以及食物停止信号任务。结果显示，STN-DBS后体重显著增加。手术后几天，患者在停止信号任务中反应更慢且更冲动，对高热量（HC）食物表现出更高的偏好，并且认为食物味道较差。丘脑底刺激数月后，停止信号任务的表现有所改善，而奖赏敏感性方面未观察到差异。有趣的是，术前注意力冲动水平较高、对低热量（LC）食物的渴望较高以及在服药状态良好/刺激开启时停止信号任务中冲动性较高的患者体重增加更多。然而，只有渴望和注意力冲动显著预测了体重变化。此外，体重增加与术后左旋多巴的减少以及疾病持续时间有关。总之，我们的研究结果与以下观点一致，即帕金森病患者在接受STN-DBS后体重增加具有多因素性质，这反映了丘脑底核复杂的功能组织。
