Deep Brain Stimulation Shown to Improve Anxiety, Depression in PD

Deep brain stimulation of the subthalamic nucleus (STN-DBS) was associated with significant improvement in symptoms of anxiety and depression among patients with Parkinson disease (PD), according to study findings published in Journal of Neurorestoratology.

PD is the second most common neurological disorder worldwide, in which patients are challenged by both motor and nonmotor symptoms. Prior research indicates that 30% to 40% of patients with PD experience stress-related neuropsychiatric symptoms of anxiety and depression that may be related to changes in brain chemistry that is caused by the disease itself.

DBS has shown efficacy for motor symptoms in advanced PD, but its effect on symptoms of anxiety and depression, which are known to cause a substantial impact on quality of life, remains unclear.

“Some studies have shown that DBS can improve symptoms of anxiety and depression in patients with PD, while others have found the opposite,” said the study authors.

They conducted a retrospective study of 57 patients with advanced idiopathic PD (male, n = 34) to assess the effect of STN-DBS on symptoms of anxiety and depression. Participants underwent bilateral STN-DBS between March 2018 and December 2018 at the Beijing Tiantan Hospital in China, with evaluations taking place preoperatively and at 1, 3, and 6-month follow-ups.

Patient scores on the Unified PD Rating Scale-Part III (UPDRS-Ⅲ), the Hamilton Anxiety Rating Scale (HAM-A;  range, 0 [no anxiety] to 56 [maximum anxiety]), the Hamilton Depression Rating Scale (HAM-D; range, 0 [no depression] to 68 [maximum depression]), and the 39-item PD Questionnaire (PDQ-39; range, 0 [no QOL impairment] to 124 [maximum QOL impairment]) were evaluated.

“One month after surgery, we turned on the stimulator and programmed the implantable pulse generator. We tested the contacts on each electrode, and selected the best stimulation target (ie, that with which the patient obtains satisfactory improvement with minimal side effects),” explained the study authors.

Findings showed that improvement rates in symptoms of anxiety and depression grew at each follow-up visit. Average improvement rates for HAM-A scores at 1, 3, and 6 months were a median (IQR) 23.5% (34.9%), 33.3% (30.9%), and 41.7% (34.9%), respectively (all P < .001), and improvement rates of median HAM-D scores at these time points were 20.0% (33.3%), 31.0% (32.7%), and 37.5% (33.4%), respectively (all, P < .001).

Moreover, positive correlations were observed between the rates of improvement in HAM-A and PDQ-39 scores (r = 0.538; P < .001) and between the rates of improvement in HAM-D and PDQ-39 scores (r = 0.404; P = .002) at the 6-month follow-up. HAM-A and HAM-D scores were also positively correlated with the Hoehn-Yahr disease staging scale (HAM-A: r = 0.296; P = .025; HAM-D: r = 0.380; P = .004).

“Future studies should pay more attention to the evaluation of nonmotor symptoms of PD, especially anxiety and depression symptoms,” concluded the researchers.

Reference

Zhang F, Wang F, Li CH, et al. Therapeutic effects of subthalamic nucleus deep brain stimulation on anxiety and depression in Parkinson’s disease patients. J Neurorestoratology. Published online March 5, 2022. doi:10.26599/JNR.2022.9040004