Accolla Ettore A, Pollo Claudio
Neurology Unit, Department of Medicine, HFR - Hôpital Cantonal Fribourg and Fribourg University, Fribourg, Switzerland.
Department of Neurosurgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Front Neurol. 2019 Jun 14;10:617. doi: 10.3389/fneur.2019.00617. eCollection 2019.
Depression in Parkinson's Disease (PD) is a prevalent and invalidating symptom. Deep brain stimulation (DBS) allows for an improvement of PD motor features, but its effects on mood are difficult to predict. Here, we review the evidence regarding mood effects after DBS of either subthalamic nucleus (STN) or globus pallidus pars interna (GPi). Different influences of multiple factors contribute to impact the neuropsychiatric outcome after surgery. Psychosocial presurgical situation, postsurgical coping mechanisms, dopaminergic treatment modifications, and direct effects of the stimulation of either target are all playing a distinct role on the psychological well-being of patients undergoing DBS. No clear advantage of either target (STN vs. GPi) has been consistently found, both being effective and with a favorable profile on depression symptoms. However, specific patients' characteristics or anatomical considerations can guide the neurosurgeon in the target choice. Further research together with technological advances are expected to confine the stimulation area within dysfunctional circuits causing motor symptoms of PD.
帕金森病（PD）中的抑郁是一种常见且使人衰弱的症状。深部脑刺激（DBS）可改善PD的运动特征，但其对情绪的影响难以预测。在此，我们综述关于丘脑底核（STN）或苍白球内侧部（GPi）进行DBS后情绪影响的证据。多种因素的不同影响有助于对术后神经精神结局产生作用。术前心理社会状况、术后应对机制、多巴胺能治疗调整以及对任一靶点刺激的直接效应，均在接受DBS患者的心理健康中发挥着独特作用。尚未始终发现任一靶点（STN与GPi）具有明显优势，两者均有效且对抑郁症状具有良好表现。然而，特定患者特征或解剖学因素可指导神经外科医生进行靶点选择。预计进一步研究以及技术进步将把刺激区域限定在导致PD运动症状的功能失调回路内。
