Table 3. DBS effects on apathy and ICDs in patients with PD.
| Author | Year | Outcome measure | Type of study | No. of patients | Main outcome after DBS |
|---|---|---|---|---|---|
| Kim et al.49 | 2013 | Primary: ICDs MMSE, BDI, modified MIDI | Retrospective | 89 STN | ICDs may resolve or improve, or new ones appear after STN DBS. Difference in risk factors for preoperative versus postoperative ICDs. |
| Lhommée et al.43 | 2012 | Secondary: Cognition mood, behavior and NMF MDRS, Frontal Score (MWCST, verbal fluency, graphic and motor series) MINI, Ardouin Scale, BDI, BAI and SAS1 | 1-year prospective multicenter | 63 STN same cohort as ref. 44 | Apathy aggravated. NMF improved. Hyperdopaminergic behaviors and appetitive functioning improved. Same cohort as ref. 44. |
| Moum et al.48 | 2012 | Primary: ICDs Chart review using current diagnostic criteria | Retrospective Chart review | 159 NA STN or GPi | ICD resolved in 2 of 7 individuals after unilateral or bilateral DBS. 17 patients developed ICD diagnoses postoperatively. |
| Shotbolt et al.46 | 2012 | Primary: ICDs Psychiatrist interview HDS, HAS and BDI | 17–41 month prospective | 29 STN | Pre-surgery: 4 patients had ICDs. All resolved after surgery but 1 recurred after 18 months. |
| Thobois S et al.51 See ref. 43 | 2010 | Primary: Apathy and mood Ardouin Scale, BDI, BAI and SAS1 | 1-year prospective multicenter | 63 STN | 34 patients developed apathy at mean 4.7 (3.3–8.2) months after DBS that was reversible in 17 at 1-year follow-up. 17 developed transient depression after 5.7 (4.7–9.3) months. Apathy, depression and anxiety can occur after surgery as a delayed dopamine withdrawal syndrome. |
| Ardouin et al.45 | 2006 | Primary: ICDs: Pathological gambling Systematic open interview by psychiatrist Secondary outcomes: cognition and mood MDRS, SAS1 and BDI-II | 3-month to 6-year (mean 18 months) retrospective data base analysis multicenter | 598 STN | Pathological gambling and other symptoms of the dopamine dysregulation syndrome improved following surgery. Apathy scores tended to increase systematically after surgery and 2 patients had a pathological score on the apathy scale in the long term. |
| Funkiewitz et al.36 | 2004 | Primary: cognition, mood and behavior MDRS and WCST Category and literal fluency and graphic and motor series BDI, UPDRS part I | 3-year prospective | 77 STN | Apathy scores mildly increased. Behavioral changes were rare and transient. |
Abbreviations: BAI, Beck Anxiety Inventory; BDI, Beck’s Depression Inventory; DBS, deep brain stimulation; HAS, Hamilton Anxiety Scale; HDS, Hamilton Depression Scale; ICD, impulse control disorders; GPi, globus pallidus interna; MDRS, Mattis Dementia Rating Scale; MIDI, Minnesota Impulsive Disorders Interview; MINI, Mini-International Neuropsychiatric Interview; MMSE, Mini-Mental State Exam; WCST, Wisconsin Card Sorting Test; NMF, non-motor fluctuations; SAS1, Starkstein Apathy Scale; STN, subthalamic nucleus; UPDRS, Unified Parkinson's Disease Rating Scale.