Lhommée Eugénie, Boyer François, Wack Maxime, Pélissier Pierre, Klinger Hélène, Schmitt Emmanuelle, Bichon Amélie, Fraix Valérie, Chabardès Stéphan, Mertens Patrick, Castrioto Anna, Kistner Andrea, Broussolle Emmanuel, Thobois Stéphane, Krack Paul
Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.
Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.
Mov Disord. 2017 Aug;32(8):1191-1200. doi: 10.1002/mds.27065. Epub 2017 Jun 23.
Subthalamic stimulation improves the motor and neuropsychiatric symptoms of Parkinson's disease. However, the impact of this treatment on impulse control and personality is the subject of heavy debate. The objective of this study was to investigate personality changes after subthalamic stimulation.
Using Cloninger's biosocial model, we assessed personality in 73 Parkinson's disease patients before and 12 months after subthalamic stimulation accompanied by a drastic reduction in dopaminergic medication. Changes in psychobehavioral symptoms were measured using a battery of validated clinical scales (apathy, depression, anxiety, hyperemotionality, mania, psychosis, punding, and impulse control behaviors).
One year after surgery, the harm avoidance personality domain total score increased compared with the baseline (+2.8; 34 patients; P < 0.001), as did 3 of its 4 subdomains: anticipatory worry (+0.7; 10 patients; P = 0.005), shyness (+0.6; 7 patients; P = 0.03), and fatigability (+1.1; 10 patients; P = 0.0014). Evolution of the shyness personality trait correlated with the decrease in dopaminergic medication. Total scores in the other personality domains remained unchanged, except for extravagance, a subdomain of novelty seeking, and persistence, a subdomain of reward dependence, which both decreased following surgery (-0.3; 7 patients; and -0.6; 9 patients; P = 0.03 and P = 0.0019, respectively). Although apathy increased, other psychobehavioral symptoms, including impulse control behaviors and neuropsychiatric nonmotor fluctuations, improved. Depression and anhedonia remained stable. Scores in hypodopaminergia and neuropsychiatric nonmotor OFF correlated with harm avoidance. Scores in hyperdopaminergia and neuropsychiatric nonmotor ON correlated with novelty seeking.
When subthalamic stimulation is applied in Parkinson's disease, significant changes in personality traits are observed, which may be related to postoperative tapering of dopaminergic treatment. © 2017 International Parkinson and Movement Disorder Society.
丘脑底核刺激可改善帕金森病的运动和神经精神症状。然而，这种治疗对冲动控制和人格的影响是激烈争论的话题。本研究的目的是调查丘脑底核刺激后的人格变化。
我们使用克隆宁格的生物社会模型，在73例帕金森病患者接受丘脑底核刺激前及刺激后12个月评估其人格，同时多巴胺能药物大幅减少。使用一系列经过验证的临床量表（冷漠、抑郁、焦虑、情绪过度、躁狂、精神病、刻板行为和冲动控制行为）测量心理行为症状的变化。
术后一年，与基线相比，避免伤害人格领域总分增加（+2.8；34例患者；P < 0.001），其4个亚领域中的3个也增加：预期担忧（+0.7；10例患者；P = 0.005）、害羞（+0.6；7例患者；P = 0.03）和易疲劳性（+1.1；10例患者；P = 0.0014）。害羞人格特质的演变与多巴胺能药物的减少相关。其他人格领域的总分保持不变，但寻求新奇的亚领域奢侈和奖赏依赖的亚领域坚持在术后均下降（分别为-0.3；7例患者；和-0.6；9例患者；P = 0.03和P = 0.0019）。尽管冷漠增加，但包括冲动控制行为和神经精神非运动波动在内的其他心理行为症状有所改善。抑郁和快感缺失保持稳定。多巴胺能不足和神经精神非运动“关”期评分与避免伤害相关。多巴胺能亢进和神经精神非运动“开”期评分与寻求新奇相关。
在帕金森病中应用丘脑底核刺激时，可观察到人格特质的显著变化，这可能与术后多巴胺能治疗的逐渐减少有关。©2017国际帕金森病和运动障碍协会。
