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Parkinson Disease: HELP
Articles by Herbert E. Ward
Based on 12 articles published since 2008
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Between 2008 and 2019, H. Ward wrote the following 12 articles about Parkinson Disease.
 
+ Citations + Abstracts
1 Clinical Trial Acute and Chronic Mood and Apathy Outcomes from a randomized study of unilateral STN and GPi DBS. 2014

Okun, Michael S / Wu, Samuel S / Fayad, Sarah / Ward, Herbert / Bowers, Dawn / Rosado, Christian / Bowen, Lauren / Jacobson, Charles / Butson, Christopher / Foote, Kelly D. ·Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America; Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America. · Department of Biostatistics, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America. · Department of Psychiatry, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America. · Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America; Department of Clinical and Health Psychology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America. · Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America. · Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States of America. · Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America. ·PLoS One · Pubmed #25469706.

ABSTRACT: OBJECTIVE: To study mood and behavioral effects of unilateral and staged bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) for Parkinson's disease (PD). BACKGROUND: There are numerous reports of mood changes following DBS, however, most have focused on bilateral simultaneous STN implants with rapid and aggressive post-operative medication reduction. METHODS: A standardized evaluation was applied to a subset of patients undergoing STN and GPi DBS and who were also enrolled in the NIH COMPARE study. The Unified Parkinson Disease Rating Scale (UPDRS III), the Hamilton depression (HAM-D) and anxiety rating scales (HAM-A), the Yale-Brown obsessive-compulsive rating scale (YBOCS), the Apathy Scale (AS), and the Young mania rating scale (YMRS) were used. The scales were repeated at acute and chronic intervals. A post-operative strategy of non-aggressive medication reduction was employed. RESULTS: Thirty patients were randomized and underwent unilateral DBS (16 STN, 14 GPi). There were no baseline differences. The GPi group had a higher mean dopaminergic dosage at 1-year, however the between group difference in changes from baseline to 1-year was not significant. There were no differences between groups in mood and motor outcomes. When combining STN and GPi groups, the HAM-A scores worsened at 2-months, 4-months, 6-months and 1-year when compared with baseline; the HAM-D and YMRS scores worsened at 4-months, 6-months and 1-year; and the UPDRS Motor scores improved at 4-months and 1-year. Psychiatric diagnoses (DSM-IV) did not change. No between group differences were observed in the cohort of bilateral cases. CONCLUSIONS: There were few changes in mood and behavior with STN or GPi DBS. The approach of staging STN or GPi DBS without aggressive medication reduction could be a viable option for managing PD surgical candidates. A study of bilateral DBS and of medication reduction will be required to better understand risks and benefits of a bilateral approach.

2 Article Interdisciplinary Parkinson's Disease Deep Brain Stimulation Screening and the Relationship to Unintended Hospitalizations and Quality of Life. 2016

Higuchi, Masa-Aki / Martinez-Ramirez, Daniel / Morita, Hokuto / Topiol, Dan / Bowers, Dawn / Ward, Herbert / Warren, Lisa / DeFranco, Meredith / Hicks, Julie A / Hegland, Karen W / Troche, Michelle S / Kulkarni, Shankar / Hastings, Erin / Foote, Kelly D / Okun, Michael S. ·Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America. · Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America. · Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida, United States of America. · Rehabilitation Services, University Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America. · Department of Speech, Language, and Hearing Sciences, University of Florida College of Public Health and Health Professions, Gainesville, Florida, United States of America. · Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, United States of America. ·PLoS One · Pubmed #27159519.

ABSTRACT: OBJECTIVE: To investigate the impact of pre-operative deep brain stimulation (DBS) interdisciplinary assessments on post-operative hospitalizations and quality of life (QoL). BACKGROUND: DBS has been utilized successfully in Parkinson's disease (PD) for the treatment of tremor, rigidity, bradykinesia, off time, and motor fluctuations. Although DBS is becoming a more common management approach there are no standardized criteria for selection of DBS candidates, and sparse data exist to guide the use of interdisciplinary evaluations for DBS screening. We reviewed the outcomes of the use of an interdisciplinary model which utilized seven specialties to pre-operatively evaluate potential DBS candidates. METHODS: The University of Florida (UF) INFORM database was queried for PD patients who had DBS implantations performed at UF between January 2011 and February 2013. Records were reviewed to identify unintended hospitalizations, falls, and infections. Minor and major concerns or reservations from each specialty were previously documented and quantified. Clinical outcomes were assessed through the use of the Parkinson disease quality of life questionnaire (PDQ-39), and the Unified Parkinson's Disease Rating Score (UPDRS) Part III. RESULTS: A total of 164 cases were evaluated for possible DBS candidacy. There were 133 subjects who were approved for DBS surgery (81%) following interdisciplinary screening. There were 28 cases (21%) who experienced an unintended hospitalization within the first 12 months following the DBS operation. The patients identified during interdisciplinary evaluation with major or minor concerns from any specialty service had more unintended hospitalizations (93%) when compared to those without concerns (7%). When the preoperative "concern" shifted from "major" to "minor" to "no concerns," the rate of hospitalization decreased from 89% to 33% to 3%. A strong relationship was uncovered between worsened PDQ-39 at 12 months and increased hospitalization. CONCLUSIONS: Unintended hospitalizations and worsened QOL scores correlated with the number and severity of concerns raised by interdisciplinary DBS evaluations. The data suggest that detailed screenings by interdisciplinary teams may be useful for more than just patient selection. These evaluations may help to stratify risk for post-operative hospitalization and QoL outcomes.

3 Article Impulsive and compulsive behaviors in Parkinson Study Group (PSG) centers performing deep brain stimulation surgery. 2014

Hack, Nawaz / Akbar, Umer / Thompson-Avila, Amanda / Fayad, Sarah M / Hastings, Erin M / Moro, Elena / Nestor, Kelsey / Ward, Herbert / York, Michele / Okun, Michael S. ·Center for Movement Disorders & Neurorestoration, University of Florida College of Medicine, Gainesville, FL, USA. · Departments of Psychiatry and Neurology, University Hospital Center of Grenoble, Grenoble, France. · Neurology, Baylor College of Medicine, Houston, TX, USA. ·J Parkinsons Dis · Pubmed #25035311.

ABSTRACT: BACKGROUND: Impulse control disorders (ICDs), dopamine dysregulation syndrome (DDS), and dopamine agonist withdrawal syndrome (DAWS) have been reported commonly in Parkinson's disease (PD) populations. The treatment approaches may be widely variable and there is not much information on these syndromes in the setting of deep brain stimulation (DBS). OBJECTIVE: To evaluate (1) ICDs, DAWS and DDS pre- and post DBS in PD and (2) to investigate pre-DBS treatment strategies regarding these behaviors among Parkinson Study Group (PSG) centers. METHODS: Forty-eight PSG centers were surveyed on ICDs, DAWS and DDS, as well as on potential relationships to DBS and treatment approaches. RESULTS: Sixty-seven percent of PSG centers reported that they served a population of over 500 PD patients per year, and 94% of centers performed DBS surgery. Most centers (92%) reported screening for ICDs, DAWS and DDS. Of the centers screening for these symptoms, 13% reported always employing a formal battery of pre-operative tests, 46% of sites inconsistently used a formal battery, while 23% of sites reported never using a formal battery to screen for these symptoms. The estimated numbers of centers observing ICDs, DAWS and DDS pre-operatively in individuals with PD were 71%, 69%, and 69%, respectively. PSG DBS centers observing at least one case of a new de novo occurrence of an ICD, DAWS or DDS after DBS surgery were 67%, 65% and 65%, respectively. CONCLUSIONS: The results suggest that addiction-like syndromes and withdrawal syndromes are prevalent in expert PSG centers performing DBS. Most centers reported screening for these issues without the use of a formal battery, and there were a large number of centers reporting ICDs, DAWS and DDS post-DBS. A single treatment strategy did not emerge.

4 Article An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting. 2014

Hack, Nawaz / Fayad, Sarah M / Monari, Erin H / Akbar, Umer / Hardwick, Angela / Rodriguez, Ramon L / Malaty, Irene A / Romrell, Janet / Shukla, Aparna A Wagle / McFarland, Nikolaus / Ward, Herbert E / Okun, Michael S. ·Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America. · Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America; Department of Psychiatry, University of Florida, Gainesville, Florida, United States of America. ·PLoS One · Pubmed #24646688.

ABSTRACT: BACKGROUND: To examine our eight year clinic-based experience in a Parkinson's disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD). METHODS: The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy. RESULTS: There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45-87 years (mean 68.3±10.15), disease duration of 17-240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r = -0.36, p<0.01) and H&Y score (r = -0.41, p<0.01) were shown to be related to response to clozapine therapy, but disease duration was not an associated factor (r = 0.21, p>0.05). CONCLUSIONS: This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting.

5 Article Valproate as a treatment for dopamine dysregulation syndrome (DDS) in Parkinson's disease. 2013

Sriram, Ashok / Ward, Herbert E / Hassan, Anhar / Iyer, Sanjay / Foote, Kelly D / Rodriguez, Ramon L / McFarland, Nikolaus R / Okun, Michael S. ·Department of Neurology, Center for Movement Disorders and Neurorestoration, Gainesville, FL 32611, USA. drashok@gmail.com ·J Neurol · Pubmed #23007193.

ABSTRACT: It has been previously well established that the use of dopaminergic agents in Parkinson's disease may contribute to behavioral disturbances such as dopamine dysregulation syndrome (DDS), impulse control disorders (ICD), and punding. ICD and punding have been most commonly addressed by reducing dose or by discontinuing the use of a dopamine agonist. Treatment of DDS has proven more challenging, and to date there has been no standard approach. In this paper, we review a series of four patients who met criteria for DDS, who were all refractory to medication adjustments. The DDS symptoms responded by the addition of valproic acid in all cases.

6 Article Clozapine as a potential treatment for refractory impulsive, compulsive, and punding behaviors in Parkinson's disease. 2013

Hardwick, A / Ward, H / Hassan, A / Romrell, J / Okun, M S. ·a Department of Neurology , Center for Movement Disorders & Neurorestoration , Gainesville , FL , USA. ·Neurocase · Pubmed #22934916.

ABSTRACT: There have been emerging cases of medication refractory obsessions, impulsivity, compulsivity, and/or punding in Parkinson's disease. These cases have proven difficult to treat, even for the experienced clinician. We report several medication refractory cases with a positive response to treatment with clozapine.

7 Article Are selective serotonin reuptake inhibitors associated with greater apathy in Parkinson's disease? 2012

Zahodne, Laura B / Bernal-Pacheco, Oscar / Bowers, Dawn / Ward, Herbert / Oyama, Genko / Limotai, Natlada / Velez-Lago, Frances / Rodriguez, Ramon L / Malaty, Irene / McFarland, Nikolaus R / Okun, Michael S. ·Department of Neurology, Center for Movement Disorders and Neuro-restoration, University of Florida, Gainesville, FL, USA. ·J Neuropsychiatry Clin Neurosci · Pubmed #23037646.

ABSTRACT: Apathy is a common neuropsychiatric feature of Parkinson's disease (PD), but little is known of relationships between apathy and specific medications in PD. Following a retrospective database and chart review of 181 Parkinson's patients, relationships between Apathy Scale scores and use of psychotropic and antiparkinsonian medications were examined with multiple regression. Controlling for age, sex, education, and depression, the use of selective serotonin reuptake inhibitors (SSRIs), but not other antidepressants, was associated with greater apathy. Use of monoamine oxidase B inhibitors was associated with less apathy. Longitudinal studies are needed to evaluate a potential SSRI-induced apathy syndrome in PD.

8 Article Effects of STN and GPi deep brain stimulation on impulse control disorders and dopamine dysregulation syndrome. 2012

Moum, Sarah J / Price, Catherine C / Limotai, Natlada / Oyama, Genko / Ward, Herbert / Jacobson, Charles / Foote, Kelly D / Okun, Michael S. ·Department of Neurology, Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America. ·PLoS One · Pubmed #22295068.

ABSTRACT: OBJECTIVE: Impulse control disorders (ICDs) and dopamine dysregulation syndrome (DDS) are important behavioral problems that affect a subpopulation of patients with Parkinson's disease (PD) and typically result in markedly diminished quality of life for patients and their caregivers. We aimed to investigate the effects of subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) on ICD/DDS frequency and dopaminergic medication usage. METHODS: A retrospective chart review was performed on 159 individuals who underwent unilateral or bilateral PD DBS surgery in either STN or GPi. According to published criteria, pre- and post-operative records were reviewed to categorize patients both pre- and post-operatively as having ICD, DDS, both ICD and DDS, or neither ICD nor DDS. Group differences in patient demographics, clinical presentations, levodopa equivalent dose (LED), and change in diagnosis following unilateral/bilateral by brain target (STN or GPi DBS placement) were examined. RESULTS: 28 patients met diagnostic criteria for ICD or DDS pre- or post-operatively. ICD or DDS classification did not differ by GPi or STN target stimulation. There was no change in DDS diagnosis after unilateral or bilateral stimulation. For ICD, diagnosis resolved in 2 of 7 individuals after unilateral or bilateral DBS. Post-operative development of these syndromes was significant; 17 patients developed ICD diagnoses post-operatively with 2 patients with pre-operative ICD developing DDS post-operatively. CONCLUSIONS: Unilateral or bilateral DBS did not significantly treat DDS or ICD in our sample, even though a few cases of ICD resolved post-operatively. Rather, our study provides preliminary evidence that DDS and ICD diagnoses may emerge following DBS surgery.

9 Article Addiction-like manifestations and Parkinson's disease: a large single center 9-year experience. 2012

Limotai, Natlada / Oyama, Genko / Go, Criscely / Bernal, Oscar / Ong, Tiara / Moum, Sarah J / Bhidayasiri, Roongroj / Foote, Kelly D / Bowers, Dawn / Ward, Herbert / Okun, Michael S. ·Department of Neurology, Center for Movement Disorders & Neurorestoration, Gainesville, Florida 32611, USA. ·Int J Neurosci · Pubmed #22023411.

ABSTRACT: OBJECTIVE: Characterize potential risk factors and the relationship of dopamine agonist (DA) withdrawal syndrome (DAWS), dopamine dysregulation syndrome (DDS), and impulse control disorders (ICDs) in Parkinson's disease (PD). METHODS: A retrospective chart review categorized cases into three groups: DAWS, DDS, and ICDs. RESULTS: A total of 1,040 subjects met inclusion criteria. There were 332 subjects with a history of tapering DAs and 26 (7.8%) developed DAWS. Fourteen (1.3%) and 89 (8.6%) met the criteria for both DDS and ICD. Subjects with DAWS, DDS, and ICDs had a higher baseline dose of DA, levodopa, and total dopaminergic medication (p < .05), compared to those without the three conditions. DDS was found to be related to the DAWS group (p < .001). When comparing to the PD population without DDS, younger age at onset of PD (p = .027), presence of DAWS (p < .001), ICDs (p = .003), and punding (p = .042) were all correlated with the DDS group, while male sex (p = .045), younger age at onset of PD (p < .001), presence of DAWS (p < .001), and presence of DDS (p = .001) and punding (p < .001) were related to the ICD group. CONCLUSIONS: There was a strong relationship between DAWS, DDS, and ICD in this large PD cohort. Dopaminergic therapy in a subset of PD patients was strongly associated with addiction-like behavioral issues.

10 Article Do stable patients with a premorbid depression history have a worse outcome after deep brain stimulation for Parkinson disease? 2011

Okun, Michael S / Wu, Samuel S / Foote, Kelly D / Bowers, Dawn / Gogna, Shilpa / Price, Catherine / Malaty, Irene / Rodriguez, Ramon L / Jacobson, Charles E / Ward, Herbert. ·UF Center for Movement Disorders & Neurorestoration, Gainesville, Florida 32607, USA. okun@neurology.ufl.edu ·Neurosurgery · Pubmed #21415789.

ABSTRACT: BACKGROUND: Deep brain stimulation (DBS) has been associated with mood sequelae in a subset of patients operated on in either the subthalamic nucleus or the globus pallidus internus for the treatment of Parkinson disease. OBJECTIVE: To compare mood and motor outcomes in those with and without a presurgical history of depression. METHODS: Unilateral subthalamic nucleus or unilateral globus pallidus internus DBS patients followed up for a minimum of 6 months were included. All patients underwent a comprehensive outpatient psychiatric evaluation by a board-certified psychiatrist. Psychiatric diagnoses were based on Diagnostic and Statistical Manual, fourth edition, text revision, nomenclature (American Psychiatric Association, 2000). Motor and mood outcomes were compared. RESULTS: A total of 110 patients were included. There were no significant differences in baseline variables between the 2 groups. Those with a preoperative history of depression had significantly higher Beck Depression Inventory scores than the nondepression group after DBS (8.97 ± 7.55 vs 5.92 ± 5.71; P = .04). Patients with a depression history had less improvement (11.6%) in pre/post-DBS change when Unified Parkinson Disease Rating Scale motor scores were compared (P = .03) after adjustment for stimulation site and baseline demographic and clinical variables. Patients with a higher levodopa equivalent dose had a worse clinical motor outcome. CONCLUSION: Patients with a preoperative depression history had higher Beck Depression Inventory scores after DBS and significantly less (albeit small) improvement in pre/post-DBS change in Unified Parkinson Disease Rating Scale motor scores than patients without a history of depression.

11 Article Do patient's get angrier following STN, GPi, and thalamic deep brain stimulation. 2011

Burdick, Adam P / Foote, Kelly D / Wu, Samuel / Bowers, Dawn / Zeilman, Pam / Jacobson, Charles E / Ward, Herbert E / Okun, Michael S. ·University of Florida Movement Disorders Center, Department of Neurosurgery, Gainesville, FL, USA. ·Neuroimage · Pubmed #20932923.

ABSTRACT: OBJECTIVE: The objective of the study was to examine whether deep brain stimulation (DBS) of the subthalamic nucleus (STN), the globus pallidus internus (GPi), and/or the ventralis intermedius thalamic nucleus (Vim) was associated with making patients angrier pre to post-surgical intervention. BACKGROUND: Secondary outcome analysis of the NIH COMPARE Parkinson's Disease DBS trial revealed that participants were angrier and had more mood and cognitive side effects following DBS. Additionally blinded on/off analysis did not change anger scores. The sample size was small but suggested that STN DBS may have been worse than GPi in provoking anger. We endeavored to examine this question utilizing a larger dataset (the UF INFORM database), and also we included a third surgical target (Vim), which has been utilized for a different disease, essential tremor. METHODS: Consecutive patients from the University of Florida Movement Disorders Center who were implanted with unilateral DBS for Parkinson's disease (STN or GPi) or essential tremor (Vim) were included. Patients originally implanted at outside institutions were excluded. Pre-operative and 4- to 6-month post-operative Visual Analog Mood Scale (VAMS) scores for all three groups were compared; additionally, pre-operative and 1- to 3-month scores were compared for STN and GPi patients. A linear regression model was utilized to analyze the relationship between the VAMS anger score and the independent variables of age, years with symptoms, Mini-Mental Status Examination (MMSE) score, handedness, ethnicity, gender, side of surgery, target of surgery, baseline Dementia Rating Scale (DRS) total score, baseline Beck Depression Index (BDI) score, micro- and macroelectrode passes, and years of education. Levodopa equivalent dosages and dopamine agonist use were analyzed for a potential impact on anger scores. RESULTS: A total of 322 unilateral DBS procedures were analyzed, with STN (n=195), Vim (n=71), and GPi (n=56) making up the cohort. An ANOVA was used to detect significant differences among the three targets in the changes pre- to post-operatively. Similar to the COMPARE dataset, at 4 months, the only subscore of VAMS to reveal a significant difference between the three targets was the angry subscore, with GPi revealing a mean (standard) change of 2.38 (9.53); STN, 4.82 (14.52); and Vim, -1.17 (11.51) (p=0.012). At 1-3 months post-operation, both STN and GPi groups were significantly angrier (p=0.004), but there was no significant difference between the two groups. However, GPi patients were significantly more confused as compared to STN patients (p=0.016). The linear regression model which sought independent explanatory variables revealed a relationship between the VAMS anger score and the surgical target and the disease duration. The mean changes for STN and GPi DBS pre- to post-operation were 11.67 (p=0.001) and 8.21 (p=0.022) units more than those with Vim, respectively. For every year added of disease duration, the VAMS anger score increased by 0.24 (p=0.022). For the GPi and STN groups, number of microelectrode passes was significantly associated with angry score changes (p=0.014), with the anger score increasing 2.29 units per microelectrode pass. Independent variables not associated with the VAMS anger score included the surgery side, handedness, gender, ethnicity, education, age at surgery, MMSE, DRS, and BDI scores. Although the STN group significantly decreased in LED when compared to GPi, there was no relationship to anger scores. Similarly, dopamine agonist use was not different between STN and GPi groups and did not correlate with the VAMS anger score changes. CONCLUSIONS: STN and GPi DBS for Parkinson's disease were associated with significantly higher anger scores pre- to post-DBS as compared to Vim for essential tremor. Anger score changes in STN and GPi patients seem to be associated with microelectrode passes, suggesting that it may be a lesional effect. PD patients with longer disease duration may be particularly susceptible, and this should be kept in mind when discussing the potential of DBS surgery for an individual patient. Essential tremor patients who on average have much longer disease durations did not get angrier. The changes in anger scores were not related to LED change or dopamine agonist use. Whether the induction of anger is disease-specific or target-specific is not currently known; however, our data would suggest that PD patients implanted in STN or GPi are at a potential risk. Finally, on closer inspection of the COMPARE DBS data, VAMS anger scores did not change on or off DBS, suggesting that anger changes may be more of a lesional effect rather than a stimulation induced one (Okun et al., 2009).

12 Article Cognition and mood in Parkinson's disease in subthalamic nucleus versus globus pallidus interna deep brain stimulation: the COMPARE trial. 2009

Okun, Michael S / Fernandez, Hubert H / Wu, Samuel S / Kirsch-Darrow, Lindsey / Bowers, Dawn / Bova, Frank / Suelter, Michele / Jacobson, Charles E / Wang, Xinping / Gordon, Clifford W / Zeilman, Pam / Romrell, Janet / Martin, Pam / Ward, Herbert / Rodriguez, Ramon L / Foote, Kelly D. ·Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Department of Neurology, Gainesville, FL 32611, USA. okun@neurology.ufl.edu ·Ann Neurol · Pubmed #19288469.

ABSTRACT: OBJECTIVE: Our aim was to compare in a prospective blinded study the cognitive and mood effects of subthalamic nucleus (STN) vs. globus pallidus interna (GPi) deep brain stimulation (DBS) in Parkinson disease. METHODS: Fifty-two subjects were randomized to unilateral STN or GPi DBS. The co-primary outcome measures were the Visual Analog Mood Scale, and verbal fluency (semantic and letter) at 7 months post-DBS in the optimal setting compared to pre-DBS. At 7 months post-DBS, subjects were tested in four randomized/counterbalanced conditions (optimal, ventral, dorsal, and off DBS). RESULTS: Forty-five subjects (23 GPi, 22 STN) completed the protocol. The study revealed no difference between STN and GPi DBS in the change of co-primary mood and cognitive outcomes pre- to post-DBS in the optimal setting (Hotelling's T(2) test: p = 0.16 and 0.08 respectively). Subjects in both targets were less "happy", less "energetic" and more "confused" when stimulated ventrally. Comparison of the other 3 DBS conditions to pre-DBS showed a larger deterioration of letter verbal fluency in STN, especially when off DBS. There was no difference in UPDRS motor improvement between targets. INTERPRETATION: There were no significant differences in the co-primary outcome measures (mood and cognition) between STN and GPi in the optimal DBS state. Adverse mood effects occurred ventrally in both targets. A worsening of letter verbal fluency was seen in STN. The persistence of deterioration in verbal fluency in the off STN DBS state was suggestive of a surgical rather than a stimulation-induced effect. Similar motor improvement were observed with both STN and GPi DBS.