Do stable patients with a premorbid depression history have a worse outcome after deep brain stimulation for Parkinson disease?
Okun MS, Wu SS, Foote KD, Bowers D, Gogna S, Price C, Malaty I, Rodriguez RL, Jacobson CE, Ward H. Do stable patients with a premorbid depression history have a worse outcome after deep brain stimulation for Parkinson disease? Neurosurgery, 2011 Aug;69(2):357-60; discussion 360-1.
The exact relationships between DBS for PD and nonmotor symptoms are commonly unknown. Such is the case for depression. The purpose of this study was to look at postsurgical outcomes for people with Parkinson’s disease (PWP) who also had a history of depression prior to the surgery versus those without any depression. An equal number of participants in this study had either unilateral DBS STN or GPi. It is also notable that the depressed individuals were successfully treated for their depression prior to the surgery. After surgical intervention, the authors found that the previously depressed group reported more symptoms of feeling depressed but their scores would still be classified in the “normal to mild” range. They also found that the younger patients and those who had PD for a longer length of time had better improvement in their motor testing. However, the previously depressed group and those taking higher dosages of levodopa experienced less improvement in their motor scores after surgery. These results are significant in assisting in the decision for one to undergo DBS. The authors concluded that PWP who have a history of depression may experience milder improvement in motor symptoms as well as mild worsening of nonmotor symptoms (e.g. depressive symptoms). It is noted that although there were statistical differences, the clinical significance of the differences was very small. The reasoning for such postsurgical differences still remains unknown, but the authors recommend the use of a multidisciplinary team (neurology, neurosurgery, neuropsychology, and psychiatry) to try to better understand 1. the relationship between a history of pre-surgery depression and outcome following DBS, 2. factors that can improve outcome predictions in DBS for those individuals with a history of depression, 3. best surgical candidates, and 4. best treatment options/best medical intervention for the PWP.