Objective: Deep brain stimulation (DBS) has been approved to relieve the motor symptoms of Parkinson’s disease (PD) patients when the optimal pharmachologic treatment is unsatisfactory. Subthalamic nucleus (STN) is the mostly targetted anatomical structure and STN DBS treatment has both advantages like decrease drug dosage and disadvantages like worsenning of some nonmotor symptoms. Apathy is one of the nonmotor symptoms of PD and has an strong effect on patients’ quality of life. The DBS studies evaluating the nonmotor symptom relief of PD patients have conflicting and indefinite results on the progress of apathy after the neuromodulation treatment.

Background: Apathy is a complex phenomenology and decrease the quality of life in PD patients. Depression , anxiety and cognition are important components both affect the presence of apathy and even confused with apathy in some cases. DBS especialy STN targetting has disadvantage of increased depression in patients after surgery and it has been accepted as a kind of dopaminergic withdrawal syndrome. Apathy is underestimated in DBS patients and risk factors for presence of apathy is still indefinite.

Methods: The study was carried out between January 2016- November 2016 with a total of 26 cases at Marmara University ,The Institude of Neurological Science, The cases were evaluated at 0 month before DBS and 6 months after DBS treatment. UPDRS, Beck anxiety and depression inventory scale, Montreal Cognitive Assesment scale (MOCA), Apathy Evaluation Scale and the PD survey -PDQ-39 were used to evaluate the apathy and related components in PD patients.

Results: The mean age of the patients was 60.38 +/- 9.10 years. The age of the onset of PD was 47.03 +/-10.27 and duration of PD was 13.73 +/- 5.39 years. There was no statistically significant difference between apathy scales of patients with 26 advanced PD patients treated with STN DBS before and at 6th month of surgery (p=0.502). Significant improvement was recorded in PDQ-39 scales before and after DBS teratment (p<0.005). Levodopa equivalent dosage of the patients was decreased by 20.28% at the 6th month. There was a negative correlation between apathy scale change percentile and levodopa equivalent dosage but not statistically significant (rs= -0.173, 0.398). Apathy was found to be a risk factor for early disease onset and advanced age of PD patients (rs= 0.093, 0.077).

Conclusions: The present study has demonstrated the evaluation of apathy before and at the 6th month of STN DBS treatment. We observed no statistically significant increase in the apathy scales of the patients. Since dopaminergic drug deprivation was noted in the mechanisms of apathy after STN DBS treatment, our acceptable Levodopa equivalent dosage decrease (20.28%) may be an important factor at the non-existence of apathy after the surgery.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluation-of-apathy-before-and-after-subthalamic-nucleus-deep-brain-stimulation-therapy-in-advanced-parkinsons-disease-patients/