Treating Apathy After Aggressive Medication Reduction Following DBS for Parkinson Disease

A trial of piribedil to treat apathy after deep brain stimulation for PD has implications for post-surgical care.

Apathy is common in Parkinson disease (PD), can be debilitating, and can have many dimensions, including motivational issues, diminished goal-directed cognition, and associated behavioral issues. In this randomized, controlled trial, researchers tested the effect of a D2/D3 agonist, piribedil, to treat apathy after bilateral subthalamic deep brain stimulation (STN DBS) surgery for PD. Of 102 patients from two medical centers, 37 met inclusion criteria for post-surgical apathy and received piribedil (titrated up to 300 mg per day) or placebo for 12 weeks. The primary outcome variable was change in Starkstein Apathy Scale score.

Seven patients in the placebo group and five in the piribedil group dropped out early. At 12 weeks, for those remain…

Reviewing Author

Michael S. Okun, MD

Disclosures

Consultant/Advisory BoardParkinson’s Foundation; Tourette Association of America

Speaker’s BureauMedscape/WebMD CME, Movement Disorders Society CME, American Academy of Neurology CME

RoyaltiesBooks4Patients; Demos; Cambridge; Taylor and Francis; Robert Rose; Public Affairs

Grant/Research SupportNational Institutes of Health; Parkinson’s Foundation; Tourette Association of America; University of Florida Foundation

Editorial BoardsTremor and Other Hyperkinetic Movements; JAMA Neurology

Leadership Positions in Professional SocietiesParkinson’s Foundation (Medical Advisor)