Eugénie Lhommée1,2,3, François Boyer1, Maxime Wack4,5, Pierre Pélissier1,2,3, Hélène Klinger6,7,8, Emmanuelle Schmitt1,2,3, Amélie Bichon1,2,3, Valérie Fraix1,2,3, Stéphan Chabardès2,3,9, Patrick Mertens7,10, Anna Castrioto1,2,3, Andrea Kistner1,2,3, Emmanuel Broussolle6,7,8, Stéphane Thobois6,7,8, Paul Krack1,2,3,11. 1. Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France. 2. Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France. 3. Inserm, U1216, Grenoble, France. 4. Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France. 5. Service d'épidémiologie et évaluation cliniques, CHU de Nancy, Vandœuvre-lès-Nancy, France. 6. Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France. 7. Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France. 8. CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France. 9. Department of neurosurgery, CHU Grenoble Alpes, Grenoble, France. 10. Hospices Civils de Lyon, Hôpital Neurologique, Neurochirurgie A, Lyon, France. 11. Present address: Department of Clinical Neuroscience, Hôpitaux Universitaires de Genève, Faculty University of Geneva, Switzerland.
Abstract
BACKGROUND: Subthalamic stimulation improves the motor and neuropsychiatric symptoms of Parkinson's disease. However, the impact of this treatment on impulse control and personality is the subject of heavy debate. The objective of this study was to investigate personality changes after subthalamic stimulation. METHODS: Using Cloninger's biosocial model, we assessed personality in 73 Parkinson's disease patients before and 12 months after subthalamic stimulation accompanied by a drastic reduction in dopaminergic medication. Changes in psychobehavioral symptoms were measured using a battery of validated clinical scales (apathy, depression, anxiety, hyperemotionality, mania, psychosis, punding, and impulse control behaviors). RESULTS: One year after surgery, the harm avoidance personality domain total score increased compared with the baseline (+2.8; 34 patients; P < 0.001), as did 3 of its 4 subdomains: anticipatory worry (+0.7; 10 patients; P = 0.005), shyness (+0.6; 7 patients; P = 0.03), and fatigability (+1.1; 10 patients; P = 0.0014). Evolution of the shyness personality trait correlated with the decrease in dopaminergic medication. Total scores in the other personality domains remained unchanged, except for extravagance, a subdomain of novelty seeking, and persistence, a subdomain of reward dependence, which both decreased following surgery (-0.3; 7 patients; and -0.6; 9 patients; P = 0.03 and P = 0.0019, respectively). Although apathy increased, other psychobehavioral symptoms, including impulse control behaviors and neuropsychiatric nonmotor fluctuations, improved. Depression and anhedonia remained stable. Scores in hypodopaminergia and neuropsychiatric nonmotor OFF correlated with harm avoidance. Scores in hyperdopaminergia and neuropsychiatric nonmotor ON correlated with novelty seeking. CONCLUSIONS: When subthalamic stimulation is applied in Parkinson's disease, significant changes in personality traits are observed, which may be related to postoperative tapering of dopaminergic treatment.
BACKGROUND:Subthalamic stimulation improves the motor and neuropsychiatric symptoms of Parkinson's disease. However, the impact of this treatment on impulse control and personality is the subject of heavy debate. The objective of this study was to investigate personality changes after subthalamic stimulation. METHODS: Using Cloninger's biosocial model, we assessed personality in 73 Parkinson's diseasepatients before and 12 months after subthalamic stimulation accompanied by a drastic reduction in dopaminergic medication. Changes in psychobehavioral symptoms were measured using a battery of validated clinical scales (apathy, depression, anxiety, hyperemotionality, mania, psychosis, punding, and impulse control behaviors). RESULTS: One year after surgery, the harm avoidance personality domain total score increased compared with the baseline (+2.8; 34 patients; P < 0.001), as did 3 of its 4 subdomains: anticipatory worry (+0.7; 10 patients; P = 0.005), shyness (+0.6; 7 patients; P = 0.03), and fatigability (+1.1; 10 patients; P = 0.0014). Evolution of the shyness personality trait correlated with the decrease in dopaminergic medication. Total scores in the other personality domains remained unchanged, except for extravagance, a subdomain of novelty seeking, and persistence, a subdomain of reward dependence, which both decreased following surgery (-0.3; 7 patients; and -0.6; 9 patients; P = 0.03 and P = 0.0019, respectively). Although apathy increased, other psychobehavioral symptoms, including impulse control behaviors and neuropsychiatric nonmotor fluctuations, improved. Depression and anhedonia remained stable. Scores in hypodopaminergia and neuropsychiatric nonmotor OFF correlated with harm avoidance. Scores in hyperdopaminergia and neuropsychiatric nonmotor ON correlated with novelty seeking. CONCLUSIONS: When subthalamic stimulation is applied in Parkinson's disease, significant changes in personality traits are observed, which may be related to postoperative tapering of dopaminergic treatment.
Authors: Thomas J C Zoon; Geeske van Rooijen; Georgina M F C Balm; Isidoor O Bergfeld; Joost G Daams; Paul Krack; Damiaan A J P Denys; Rob M A de Bie Journal: Mov Disord Date: 2020-12-16 Impact factor: 10.338