TY - JOUR
T1 - Apathy following Bilateral Deep Brain Stimulation of Subthalamic Nucleus and Globus Pallidus Internus in Parkinson's Disease
T2 - A Meta-Analysis
AU - Zhang, Song
AU - Zi, Shumei
AU - Xiong, Sihuai
AU - Peng, Heng
AU - Hu, Kejia
AU - He, Hua
N1 - This study was supported by the Shanghai Municipal Health Commission Clinical Study Special Fund (KH, 20194Y0067), Medical and Engineering Cross Research Fund from Shanghai Jiao Tong University (KH, YG2019QNA31), Ruijin Youth NSFC Cultivation Fund (KH, 2021&2019), Ruijin Hospital Guangci Excellence Youth Training Program (KH, GCQN-2019-B10), Shanghai Pujiang Program (KH, 19PJ1407500); The Initiation Grant for Faculty Niche Research Area from Hong Kong Baptist University (HP, RCFNRA- IG/20-21/SCI/05), The Hong Kong Research Grant Council (HP, 12303618, 12302022).
Publisher Copyright:
© 2022 Song Zhang et al.
PY - 2022/10/3
Y1 - 2022/10/3
N2 - Parkinson's disease (PD) is a progressive neurodegenerative disorder typically manifested by its motor symptoms. In addition, PD patients also suffer from many nonmotor symptoms (NMSs), such as apathy. Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the globus pallidus internus (GPi) are recommended as therapeutic interventions for PD, given their pronounced benefit in reducing troublesome dyskinesia. Apathy, a mood disorder recognized as a NMS of PD, has a negative impact on the prognosis of PD patients. However, the effect of STN-DBS and GPi-DBS on apathy is controversial. In the current meta-analysis, we analyzed apathy following bilateral STN-DBS and GPi-DBS in PD patients. Relevant literature was retrieved from public databases, including PubMed, Cochrane Library, and Embase. Studies were included in our analysis based on the following criterion: such studies should report apathy scores presurgery and postsurgery determined by using the Starkstein Apathy Scale or Apathy Evaluation Scale in patients receiving STN or GPi-DBS with at least three months of follow-up. Upon applying this strict criterion, a total of 13 out of 302 studies were included in our study. A mean difference (MD) and 95% confidence interval (CI) were calculated to show the change in apathy scores. We found a statistically significant difference between the presurgery and postsurgery scores in patients receiving STN-DBS (MD = 2.59, 95% CI = 2.23-2.96, P<0.00001), but not in patients receiving GPi-DBS (MD = 0.32, 95% CI = -2.78-3.41, P=0.84). STN-DBS may worsen the condition of apathy, which may result from the reduction of dopaminergic medication. In conclusion, STN-DBS seems to relatively worsen the condition of apathy compared to GPi-DBS. Further studies should focus on the mechanisms of postoperatively apathy and the degree of apathy in STN-DBS versus GPi-DBS.
AB - Parkinson's disease (PD) is a progressive neurodegenerative disorder typically manifested by its motor symptoms. In addition, PD patients also suffer from many nonmotor symptoms (NMSs), such as apathy. Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the globus pallidus internus (GPi) are recommended as therapeutic interventions for PD, given their pronounced benefit in reducing troublesome dyskinesia. Apathy, a mood disorder recognized as a NMS of PD, has a negative impact on the prognosis of PD patients. However, the effect of STN-DBS and GPi-DBS on apathy is controversial. In the current meta-analysis, we analyzed apathy following bilateral STN-DBS and GPi-DBS in PD patients. Relevant literature was retrieved from public databases, including PubMed, Cochrane Library, and Embase. Studies were included in our analysis based on the following criterion: such studies should report apathy scores presurgery and postsurgery determined by using the Starkstein Apathy Scale or Apathy Evaluation Scale in patients receiving STN or GPi-DBS with at least three months of follow-up. Upon applying this strict criterion, a total of 13 out of 302 studies were included in our study. A mean difference (MD) and 95% confidence interval (CI) were calculated to show the change in apathy scores. We found a statistically significant difference between the presurgery and postsurgery scores in patients receiving STN-DBS (MD = 2.59, 95% CI = 2.23-2.96, P<0.00001), but not in patients receiving GPi-DBS (MD = 0.32, 95% CI = -2.78-3.41, P=0.84). STN-DBS may worsen the condition of apathy, which may result from the reduction of dopaminergic medication. In conclusion, STN-DBS seems to relatively worsen the condition of apathy compared to GPi-DBS. Further studies should focus on the mechanisms of postoperatively apathy and the degree of apathy in STN-DBS versus GPi-DBS.
UR - http://www.scopus.com/inward/record.url?scp=85140008669&partnerID=8YFLogxK
U2 - 10.1155/2022/4204564
DO - 10.1155/2022/4204564
M3 - Review article
AN - SCOPUS:85140008669
SN - 2090-8083
VL - 2022
JO - Parkinson's Disease
JF - Parkinson's Disease
M1 - 4204564
ER -
