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Functional and dysfunctional impulsivities changes after subthalamic nucleus-deep brain stimulation in Parkinson disease
Neurochirurgie ( IF 1.6 ) Pub Date : 2021-04-09 , DOI: 10.1016/j.neuchi.2021.03.013
R Kardous 1 , H Joly 2 , B Giordana 3 , L Stefanini 3 , A Mulliez 4 , C Giordana 5 , J-J Lemaire 6 , D Fontaine 7
Affiliation  

Objectives

We investigated changes of impulsivity after deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) patients, distinguishing functional from dysfunctional impulsivity and their contributing factors.

Methods

Data of 33 PD patients treated by STN-DBS were studied before and 6 months after surgery: motor impairment, medication (dose and dopaminergic agonists), cognition, mood and occurrence of impulse control disorders. Impulsivity was assessed by the Dickman Impulsivity Inventory, which distinguishes functional impulsivity (FI), reflecting the potential for reasoning and rapid action when the situation requires it, and dysfunctional impulsivity (DI), reflecting the lack of prior reasoning, even when the situation demands it. The location of DBS leads was studied on postoperative MRI using a deformable histological atlas and by compartmentalization of the STN.

Results

After STN-DBS, DI was significantly increased (mean pre- and postoperative DI scores 1.9 ± 1.6 and 3.5 ± 2.4, P < 0.001) although FI was not modified (mean pre- and postoperative FI scores 6.2 ± 2.7 and 5.8 ± 2.6). Factors associated with a DI score's increase  2 (multivariable logistic regression model) were: low preoperative Frontal Assessment Battery score and location of the left active contact in the ventral part of the STN.

Conclusion

Our study suggests that STN-DBS may have a different impact on both dimensions of impulsivity, worsening pathological impulsivity without altering physiological impulsivity. The increase in dysfunctional impulsivity may be favoured by the location of the electrode in the ventral part of the STN.



中文翻译:

帕金森病丘脑底核深部脑刺激后的功能性和功能障碍性冲动变化

目标

我们调查了帕金森病 (PD) 患者丘脑底核 (STN) 深部脑刺激 (DBS) 后冲动的变化,区分功能性冲动和功能障碍冲动及其影响因素。

方法

研究了 33 名接受 STN-DBS 治疗的 PD 患者在手术前和手术后 6 个月的数据:运动障碍、药物(剂量和多巴胺能激动剂)、认知、情绪和冲动控制障碍的发生。Dickman Impulsivity Inventory 评估了冲动性,它区分了功能性冲动性 (FI),反映了在情况需要时推理和快速行动的潜力,以及功能失调性冲动性 (DI),反映了缺乏事先推理,即使情况需要它。使用可变形的组织学图谱和 STN 的分隔在术后 MRI 上研究 DBS 导线的位置。

结果

STN-DBS 后,DI 显着增加(平均术前和术后 DI 评分为 1.9  ±  1.6 和 3.5  ±  2.4,P  <  0.001),尽管 FI 未修改(平均术前和术后 FI 评分为 6.2  ±  2.7 和 5.8  ±  2.6) . 与 DI 评分增加  2(多变量逻辑回归模型)相关的因素是:术前正面评估电池评分低和 STN 腹侧左侧主动接触的位置。

结论

我们的研究表明 STN-DBS 可能对冲动的两个维度产生不同的影响,在不改变生理冲动的情况下恶化病理冲动。电极位于 STN 腹侧部分可能有利于增加功能失调的冲动。

更新日期:2021-04-09
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