Neurocircuitry of apathy in Parkinson’s patients with subthalamic nucleus deep brain stimulation.
Poster No:
2
Submission Type:
Abstract Submission
Authors:
Jip de Bruin1, Ki Sueng Choi1, Helen Mayberg1, Joohi Jimenez-Shahed1, Christina Palmese1, Juna Khang1, Ha Neul Song1, Brian Kopell1, Martijn Figee1
Institutions:
1Icahn School of Medicine at Mount Sinai, New York, NY
First Author:
Co-Author(s):
Introduction:
Subthalamic nucleus deep brain stimulation (STN DBS) improves motor symptoms of Parkinson's disease (PD), but its effect on motivation is controversial. Apathy, characterized by lack of motivation and energy, commonly occurs in PD, and is often exacerbated after STN DBS and post-surgical levodopa withdrawal. Apathy is linked to dopaminergic denervation in limbic and associative pathways which are not typically targeted with STN DBS. Similar to motor symptoms, apathy can be a levodopa-responsive PD symptom. The routine withdrawal of levodopa after surgery could therefore reveal apathy when these non-motor pathways are not stimulated with STN DBS. Here, we examined the moderating role of levodopa withdrawal on the relationship between postoperative apathy and the structural connectivity of stimulation volumes to limbic and associative networks.
Methods:
Apathy scores and medication information were collected in 28 PD patients before and six months after STN DBS. We modeled stimulation volumes and structural connectivity patterns using patient-specific diffusion-weighted magnetic resonance images and probabilistic tractography. First, we explored the interaction between medication reduction and stimulation of limbic, associative, and motor pathways on apathy change. Second, we investigated the modulatory role of medication withdrawal by testing the relationship between apathy change score and stimulation-related connectivity separately in patients with high (N = 17) and low (N = 11) medication withdrawal.
Results:
Apathy increased after STN DBS in 13 of the 28 patients. There was a significant interaction between medication withdrawal and left ventromedial prefrontal cortex (vmPFC) involvement on change in apathy. In patients with high medication withdrawal, DBS-related apathy was associated with lower connectivity of the stimulation volume to the left ventromedial prefrontal cortex and orbital frontal cortex. The change in apathy was unrelated to motor pathway connectivity, or motor symptoms. These findings were additionally used for a tractography guided change in stimulation parameters for a case example with apathy post DBS. Which resulted in a significant apathy decrease.
·Interaction: vmPFC connectivity and medication reduction.
·Correlations between connectivity and apathy change.
Conclusions:
Our study suggests that insufficient stimulation of limbic fronto-subthalamic network connections combined with high levodopa withdrawal contributes to STN DBS-related apathy in PD, which may inspire novel personalized non-motor targeting strategies.
Brain Stimulation:
Deep Brain Stimulation 1
Disorders of the Nervous System:
Neurodegenerative/ Late Life (eg. Parkinson’s, Alzheimer’s)
Psychiatric (eg. Depression, Anxiety, Schizophrenia)
Emotion, Motivation and Social Neuroscience:
Emotion and Motivation Other 2
Modeling and Analysis Methods:
Diffusion MRI Modeling and Analysis
Keywords:
Movement Disorder
Other - Parkinson's disease; Subthalamic Nucleus; Deep Brain Stimulation; Apathy; Probabilistic tractography
1|2Indicates the priority used for review
Provide references using author date format
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