Deep Brain Stimulation of the Nucleus Accumbens Has Positive Effects on Parkinson's Disease-Related Apathy (P7.050)

OBJECTIVE: To present the case of a 61-year-old male with a history of depression, obsessive-compulsive disorder, Parkinson’s disease (PD) and PD-related apathy, who received bilateral deep brain stimulation implantation in the Nucleus accumbens (NAcc). BACKGROUND: Deep brain stimulation (DBS) is a technique that consists of an implanted lead that provides neural-network modulation within a brain circuit(s) of interest. DBS has been approved to treat the movement disorder, PD. The apathy related to Parkinson’s disease is a common and disabling symptom. There is no reported DBS target that has been shown to improve apathy in Parkinson’s patients. The NAcc has been implicated as an important node in the neurocircuitry of seeking behavior as well as in the pathophysiology of Parkinson’s-related apathy. DESIGN/METHODS: Our patient opted to receive a DBS implantation in the NAcc targeted for OCD (FDA HDE), but recognizing that the patient had co-morbid, severe apathy and depression. The patient had a Yale Brown Obsessive Compulsive Scale (YBOCS) score of 32 (EXTREME), an Apathy Scale (AS) score of 22 (SIGNIFICANT), and Hamilton Depression Rating Scale-17 item (HAMD-17) score of 30 (VERY SEVERE) prior to deep brain stimulation surgery. RESULTS: After 3 months, the patient has achieved not only a reduction in YBOCS score to 12-MILD(-62.5%), but also a reduction in AS score to 7-MILD(-68.2%) and HAMD-17 score to 10-MILD(-66.7%). CONCLUSIONS: This is the first report of NAcc implantation in a patient with Parkinson’s disease. This case demonstrates that in addition to treating obsessive-compulsive disorder, DBS of the NAc can have positive effects on Parkinson’s-related apathy. This case facilitates discussion of the functional neuroanatomy of goal-directed behavior, modulating motivation, arousal, motor response, and sensorimotor integration as well as DBS’s putative mechanism in modulating those networks. Study Supported by: NIH Grant # R25 DA020537-06 Back, SE & Brady, KT(PI) Disclosure: Dr. Williams has nothing to disclose. Dr. Short has nothing to disclose. Dr. Williams has nothing to disclose. Dr. Jeffery has nothing to disclose. Dr. Kerns has nothing to disclose. Dr. Sahlem has nothing to disclose. Dr. Hanlon has nothing to disclose. Dr. Revuelta has nothing to disclose. Dr. Takacs has nothing to disclose. Dr. George has nothing to disclose.