Mood Stability in Parkinson’s Disease Status Post Deep Brain Stimulation: A 6-Month Prospective Follow-up Study

, Abstract Objective— Deep brain stimulation (DBS) for Parkinson’s disease (PD) has been associated with psychiatric adverse effects (PAEs) including anxiety, depression, mania, psychosis and suicide. The purpose of this study was to evaluate safety of DBS in a large PD clinical practice. Methods— Patients approved for surgery by Mayo Clinic DBS clinical committee participated in a 6 month prospective naturalistic follow-up study. In addition to the Unified Parkinson’s Disease Rating Scale (UPDRS), stability and psychiatric safety was measured using: Beck Depression Inventory (BDI-II), Hamilton Depression Rating Scale (HAMD-17), and Young Mania Rating scale (YMRS). Outcomes were compared in PD patients with past psychiatric history to PD patients with no comorbid psychiatric history. Results— Forty-nine of 54 patients completed the study. Statistically significant 6-month baseline to endpoint improvement was found in motor and mood scales. No significant differences were found in psychiatric outcomes based on presence or absence of psychiatric comorbidity. Conclusions— Our study suggests PD patients with a history of psychiatric comorbidity can safely respond to DBS with no greater risk of PAE occurrence. A multi-disciplinary team approach including careful psychiatric screening ensuring mood stabilization and psychiatric follow-up should be viewed as standard of clinical care to optimize psychiatric outcome in the course of DBS treatment. have been implicated etiologic factors contributing to DBS associated PAEs. There is a lack of large-scale prospective studies focusing on DBS associated PAEs and the existing studies are not without methodological limitations including very small sample sizes and lack of control groups. Results of our prospective longitudinal study underscore overall safety of DBS in carefully screened PD patients with and without pre-existing psychiatric disorders. In our study, despite previous history of psychiatric disorders in 27/54 (50%) of the patients, depressive symptoms improved in all three groups as evident by modest reduction in BDI-II and HAM-D scores during 6 month follow-up. Lower incidence of new onset PAEs in our study is likely related to both small sample size and study duration, particularly for suicidality, and a comprehensive psychiatric screening and followup ensuring mood stabilization in PD patients with psychiatric comorbidity prior to the DBS surgery. This carefully screened population does limit ability to generalize to larger clinical trial populations as it relates to safety. Our results are consistent with improvement in depression after DBS as noted in a previous study during the immediate postoperative period (21). The authors have reported

，抽象的目标 - 帕金森氏病（PD）的大脑模拟（DBS）与精神病患者（PAE）有关，包括焦虑，抑郁症，躁狂症，精神病和自杀。除了统一的帕金森氏病评级量表（UPDRS）外，稳定性和精神病性安全还使用：贝克抑郁症（BDI-II），汉密尔顿抑郁率评级量表（HAMD-17）和年轻的躁狂评级量表（YMRS）与PD患者的PD患者相比。在统计学上，基于统计学意义的6个月基线至终点，并在精神病学结论中发现了精神病的差异。精神病筛查确保情绪稳定和精神病随访应视为临床护理的标准，以优化DBS治疗过程中的精神病学结果。我们的前瞻性纵向研究的结果是，在我们的研究中，精心筛选的PD患者和没有预先存在的精神病患者的抑郁症状（50％）（50％）的抑郁症我们的研究可能与较小的样本量和研究持续时间有关，尤其是为了自杀，并进行了全面的精神筛查，并确保在DBS手术之前，精神病患者的PD患者的情绪稳定性确实限制了与我们的抑郁症相关的较大临床试验的能力。在术后直接的研究（21）。