Deep Brain Stimulation of the Subthalamic Nucleus
Improves Mood
Laurie Barclay, MD
March 14, 2003 �?Deep brain stimulation (DBS) of the
subthalamic nucleus as a treatment for Parkinson's
disease (PD) significantly enhances positive mood and
emotional memory, according to a report in the March
issue of the Archives of General Psychiatry. This
observation may advance our understanding of the
neurobiological basis of emotions and mood disorders.
"High-frequency electrical stimulation of the
subthalamic nucleus is a new and highly effective
therapy for complications of long-term levodopa
therapy and motor symptoms in advanced PD," write
Frank Schneider, MD, PhD, from the University of
Düsseldorf in Germany, and colleagues. "Clinical
observations indicate additional influence on
emotional behavior."
In 12 patients with PD, Dr. Schneider's group compared
the effects of DBS of the subthalamic nucleus with
those of a suprathreshold dose of levodopa intended to
transiently restore striatal dopamine deficiency.
During DBS, self-reported mood and emotional memory
improved and mood induction effect was enhanced, but
cognitive performance did not change. These effects
were comparable to those of levodopa.
Study limitations include the time-consuming nature of
the experimental procedure, which prevented testing
medication effects in randomized order; small sample
size; and inability to blind patients to the
stimulation state. However, the authors suggest that
the affective changes following levodopa or DBS did
not simply reflect a reaction to improved motor
function.
"DBS of the subthalamic nucleus selectively enhanced
affective processing and subjective well-being and
seemed to be antidepressive. Levodopa and DBS had
similar effects on emotion," the authors write. "This
finding may provide new clues about the neurobiologic
bases of emotion and mood disorders, and it
illustrates the important role of the basal ganglia
and the dopaminergic system in emotional processing in
addition to the well-known motor and cognitive
functions."
Arch Gen Psychiatry. 2003;60:296-302
Reviewed by Gary D. Vogin, MD
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