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Master Thesis

La dépression dans la maladie de Parkinson après stimulation cérébrale profonde‎ : hypothèse hypodopaminergique et intérêt du traitement par agonistes dopaminergiques

Abstract : In Parkinson's disease, apathy occurs often and depression sometimes, during the year after subthalamic stimulation. These symptoms would be hypodopaminergic, related to the disease. A study demonstrates the efficacy of piribedil, a D2/D3 dopamine agonist, to reverse apathy after surgery. This study showed a trend to improvement of depression, which was not statistically significant, probably because of a lack of power. We wanted to study impact of dopamine agonist on depression after subthalamic stimulation, and predictors of postoperative depression. We included retrospectively 14 patients who became severe depressed, with a Beck Depression Inventory-II (BDI-II) score ≥28, among 102 patients which were monthly monitored during the postoperative year. Patients were treated by dopamine agonist and/or by antidepressant drugs. The endpoint was change of depression score (BDI-II) 3 month later. Patients were responders when BDI-II score decrease ≥30%. Severe depression (mean BDI-II score: 33.8 +/-14.5 points) occurred after a mean of 5.9 +/- 2.1 months in 14 patients (13.7%). At baseline preoperative assessment, non-motor fluctuations especially in depression, and depression score in OFF drug condition were greater in the group with postoperative depression. Whatever the treatment they received, BDI-II score improved of 60.66% and decreased 20.5 +/- 10.3 points. 12 patients among 14 were responders. Under dopamine agonist only (n=6), depression improved in 5 patients. Depression, after dopamine withdrawal, can be reversed by dopamine agonist. These findings support the dopaminergic hypothesis of depression in Parkinson's disease.
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Master Thesis
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Amélie Serra. La dépression dans la maladie de Parkinson après stimulation cérébrale profonde‎ : hypothèse hypodopaminergique et intérêt du traitement par agonistes dopaminergiques. Médecine humaine et pathologie. 2012. ⟨dumas-00924853⟩

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