Contact-dependent reproducible hypomania induced by Deep Brain Stimulation in Parkinson's disease: Clinical, anatomical and functional imaging study
Résumé
Hypomanic symptoms depending on anatomical location of contacts are reported in Parkinson's disease (PD) patients treated by deep-brain-stimulation (DBS) of subthalamic nucleus (STN) area. However, the underlying cortical and subcortical dysfunction remains debated. In this study, we investigated five PD patients implanted with DBS-STN who presented reversible and reproducible hypomanic symptoms after stimulation of specific "manic" contacts. Hypomanic symptoms were assessed using the Bech and Rafaelsen Mania Scale (MAS). A 3-D anatomical location of "euthymic" and "manic" contacts, after matching post operative CT scan with pre-operative stereotactic MRI, and a H215O PET study in conditions testing "euthymic" and "manic" contacts, were performed. In the "euthymic" condition, MAS score (mean ± SD) was 0.6 ± 0.5 compared to 7.8 ± 3.1 in the "manic" condition. Nine of ten "manic" contacts were located in the substantia nigra mainly in its ventral part. PET showed that hypomania was associated with a strong asymmetrical cerebral activation involving preferentially the right hemisphere, and was mediated by an activation of the anterior cingulate and medial prefrontal cortex. The present study demonstrates the role of subcortical structures in the genesis of hypomania in PD patients treated with DBS and stresses the implication of substantia nigra.
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