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Research paper
Postoperative apathy can neutralise benefits in quality of life after subthalamic stimulation for Parkinson's disease
  1. Raul Martinez-Fernandez1,2,3,
  2. Pierre Pelissier1,2,
  3. Jean-Louis Quesada4,5,
  4. Hélène Klinger6,7,8,
  5. Eugénie Lhommée1,2,
  6. Emmanuelle Schmitt1,2,
  7. Valerie Fraix1,2,
  8. Stephan Chabardes1,2,9,
  9. Patrick Mertens7,10,
  10. Anna Castrioto1,2,
  11. Andrea Kistner1,2,
  12. Emmanuel Broussolle6,7,8,
  13. Pierre Pollak1,2,11,
  14. Stéphane Thobois6,7,8,
  15. Paul Krack1,2
  1. 1Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France
  2. 2INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France
  3. 3CINAC-HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain
  4. 4Centre d'Investigation Clinique, CHU de Grenoble, Univesité Joseph Fourier, Grenoble, France
  5. 5Direction de la recherche clinique, Département scientifique, CHU Grenoble, Grenoble, France
  6. 6Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France
  7. 7Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France
  8. 8CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
  9. 9Deparment of Neurosurgery, CHU de Grenoble, Grenoble, France
  10. 10Hospices Civils de Lyon, Hôpital Neurologique, Neurochirurgie A, Lyon, France
  11. 11Service de Neurologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
  1. Correspondence to Paul Krack, Pavillon de Neurologie, CHU Grenoble, Grenoble Cedex 9 38043, France; paul.krack{at}


Background Subthalamic nucleus deep brain stimulation (STN-DBS) improves motor symptoms of Parkinson's disease, leading to improvement in health-related quality of life (HRQoL). However, an excessive decrease in dopaminergic medication can lead to a withdrawal syndrome with apathy as the predominant feature. The present study aims to assess the impact of postoperative apathy on HRQoL.

Methods A cohort of 88 patients who underwent STN-DBS was divided into two groups, those who were apathetic at 1 year and those who were not, as measured by the Starkstein scale. HRQoL was assessed using the Parkinson's disease questionnaire 39 (PDQ-39) and was compared between the two groups. We also compared activities of daily living, motor improvement and motor complications (Unified Parkinson's Disease Rating Scale, UPDRS), depression and anxiety, as well as cognition and drug dosages. Baseline characteristics and postoperative complications were recorded.

Results One year after surgery, 27.1% of patients suffered from apathy. While motor improvement was significant and equivalent in both the apathy (−40.4% of UPDRS motor score) and non-apathy groups (−48.6%), the PDQ-39 score did not improve in the apathy group (−5.5%; p=0.464), whereas it improved significantly (−36.7%; p≤0.001) in the non-apathy group. Change in apathy scores correlated significantly with change in HRQoL scores (r=0.278, p=0.009). Depression and anxiety scores remained unchanged from baseline in the apathy group (p=0.409, p=0.075), while they improved significantly in patients without apathy (p=0.006, p≤0.001). A significant correlation was found between changes in apathy and depression (r=0.594, p≤0.001).

Conclusions The development of apathy after STN-DBS can cancel out the benefits of motor improvement in terms of HRQoL. Systematic evaluation and management of apathy occurring after subthalamic stimulation appears mandatory.


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