Faculty of Arts, University of Melbourne, Melbourne, Australia.
School of Psychology, Deakin University, Melbourne, Australia.
Neuropsychol Rev. 2021 Sep;31(3):385-401. doi: 10.1007/s11065-020-09467-z. Epub 2021 Feb 19.
This meta-analysis examines mood changes after bilateral subthalamic deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). Deep brain stimulation improves motor outcomes in Parkinson's disease but there appears to be conflicting reports as to subsequent mood outcomes. Pubmed, PsychINFO and SCOPUS were searched for studies assessing mood outcomes in PD patients who had undergone STN-DBS published between January 2003 and the end of January 2019. Random effects meta-analyses were conducted for all outcome groups with at least two studies homogenous in design and measure. Forty-eight studies, providing data on negative moods (such as depression, anxiety, apathy, and anger) and positive moods (pleasure and euphoria) were assessed. Results of the meta-analysis suggest that post-DBS, depression and anxiety symptoms improve and there is a reduction in negative affect, an increase in apathy, and in energy level. Although there have been reported cases of mania post-DBS surgery, the meta-analysis suggested no significant changes in symptoms of mania in the broader DBS population. Considerable heterogeneity was found and partially addressed through meta-regression and qualitative assessment of the included STN-DBS controlled studies. The major strengths of this meta-analysis, include attention to outcome validity, heterogeneity, independence of samples, and clinical utility, with the potential to improve post-operative safety through comprehensive consideration of mood and psychological adjustment. It appears that STN-DBS is a relatively safe and, in the case of mood symptomatology, an advantageous treatment of Parkinson's disease.
这项荟萃分析研究了双侧丘脑底核深部脑刺激（STN-DBS）后帕金森病（PD）患者的情绪变化。深部脑刺激改善了帕金森病的运动结果，但随后的情绪结果似乎存在相互矛盾的报告。在 2003 年 1 月至 2019 年 1 月底期间，在 Pubmed、PsychINFO 和 SCOPUS 上搜索了评估接受 STN-DBS 的 PD 患者情绪结果的研究。对于至少有两项设计和测量同质的研究的所有结果组进行了随机效应荟萃分析。评估了 48 项研究，这些研究提供了关于负性情绪（如抑郁、焦虑、淡漠和愤怒）和正性情绪（愉悦和欣快）的数据。荟萃分析结果表明，DBS 后抑郁和焦虑症状改善，负性情绪减少，淡漠和精力水平增加。尽管有报道称 DBS 手术后出现躁狂症，但荟萃分析表明，在更广泛的 DBS 人群中，躁狂症症状没有明显变化。发现了相当大的异质性，并通过荟萃回归和对纳入的 STN-DBS 对照研究进行定性评估部分解决了这一问题。这项荟萃分析的主要优势包括对结果有效性、异质性、样本独立性和临床实用性的关注，通过全面考虑情绪和心理调整，有可能提高术后安全性。STN-DBS 似乎是一种相对安全的治疗方法，在情绪症状方面，是帕金森病的有利治疗方法。
