Research Article Impact of Combined Subthalamic Nucleus and Substantia Nigra Stimulation on Neuropsychiatric Symptoms in Parkinson’s Disease Patients U. Hidding, 1 A. Gulberti, 1,2 A. Horn, 1 C. Buhmann, 1 W. Hamel, 3 J. A. Koeppen, 3 M. Westphal, 3 A. K. Engel, 2 C. Gerloff, 1 D. Weiss, 4 C. K. E. Moll, 2 and M. Pötter-Nerger 1 1 Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany 2 Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany 3 Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany 4 Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of T¨ ubingen, 72076 T¨ ubingen, Germany Correspondence should be addressed to M. P¨ otter-Nerger; m.poetter-nerger@uke.de Received 9 September 2016; Revised 30 November 2016; Accepted 8 December 2016; Published 26 January 2017 Academic Editor: Zoltan Mari Copyright © 2017 U. Hidding et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Te goal of the study was to compare the tolerability and the efects of conventional subthalamic nucleus (STN) and combined subthalamic nucleus and substantia nigra (STN+SNr) high-frequency stimulation in regard to neuropsychiatric symptoms in Parkinson’s disease patients. In this single center, randomized, double-blind, cross-over clinical trial, twelve patients with advanced Parkinson’s disease (1 female; age: 61.3±7.3 years; disease duration: 12.3±5.4 years; Hoehn and Yahr stage: 2.2±0.39) were included. Apathy, fatigue, depression, and impulse control disorder were assessed using a comprehensive set of standardized rating scales and questionnaires such as the Lille Apathy Rating Scale (LARS), Modifed Fatigue Impact Scale (MFIS), Becks Depression Inventory (BDI-I), Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease Rating Scale (QUIP-RS), and Parkinson’s Disease Questionnaire (PDQ-39). Tree patients that were initially assigned to the STN+SNr stimulation mode withdrew from the study within the frst week due to discomfort. Statistical comparison of data retrieved from patients who completed the study revealed no signifcant diferences between both stimulation conditions in terms of mean scores of scales measuring apathy, fatigue, depression, impulse control disorder, and quality of life. Individual cases showed an improvement of apathy under combined STN+SNr stimulation. In general, combined STN+SNr stimulation seems to be safe in terms of neuropsychiatric side efects, although careful patient selection and monitoring in the short-term period afer changing stimulation settings are recommended. 1. Introduction Neuropsychiatric symptoms in Parkinson’s disease (PD) rep- resent a common, disabling, occasionally socially disruptive condition; they are difcult to treat and have a major impact on quality of life [1, 2]. Emotional neuropsychiatric symptoms represent a spectrum of various phenomena including apathy, fatigue, and depression on the one hand and impulse control disorder and mania on the other hand [1, 3]. Emotional symptoms are related to several factors such as environmental and cultural infuences or personality traits. Of particular importance is the relation of neuropsychiatric symptoms to the disease itself, as in the case of apathy and depression, and the relation to the antiparkinsonian treatment observed for impulse control disorder [1, 4]. Apathy, fatigue, and depression are common and disabling symptoms preced- ing the onset of motor symptoms by several years [5]. In the pathophysiological understanding of neuropsychiatric symptoms, observations of early alpha synuclein pathology of nondopaminergic brainstem nuclei such as the locus coeruleus (LC) and the raphe nuclei have shed new light on the role of brainstem nuclei and basal ganglia-brainstem projections [6, 7]. Particularly, the noradrenergic LC moved into the focus of interest, since the LC is interconnected Hindawi Parkinson’s Disease Volume 2017, Article ID 7306192, 14 pages https://doi.org/10.1155/2017/7306192