Vliv hluboké mozkové stimulace subthalamického jádra na emoční a motivační procesy u pacientů s Parkinsonovou nemocí

Souhrn: Mechanismus nárůstu hmotnosti nebo afektivních a behaviorálních změn, které se vyskytují u pacientů s Parkinsonovou nemocí (PN) léčených hlubokou mozkovou stimulací subthalamického jádra (DBS STN) je nejasný. Domnívali jsme se, že některé tyto nonmotorické vedlejší účinky mohou být způsobené ovlivněním motivačních procesů. Motivační procesy vyvolané příjemnými a nepříjemnými podněty mohou být subjektivně hodnoceny pomocí přisouzení motivační důležitosti podnětům nebo pomocí afektivní modulace úlekové reakce. Ta poskytuje objektivní míru změn v emoční reaktivitě: úleková reakce je fyziologicky zesílena nepříjemnými a oslabena příjemnými podněty, tyto změny odráží aktivaci averzivního a apetitivního motivačního systému. Cílem naší práce bylo hodnocení vlivu DBS STN na motivační procesy vyvolané obrázky ze 4 různých kategorií: dvě zobrazující primární odměny erotiku a jídlo, averzivní podněty (hrozby a oběti) a neutrální pomocí subjektivních přisouzení motivační důležitosti prezentovaným podnětům (Studie 1.) a pomocí modulace akustického blink reflexu (ABR) (Studie 2.) u pacientů s PN po celonočním vysazení dopaminergní medikace ve stavu s se zapnutou (DBS ON) a vypnutou (DBS OFF) stimulací. Výsledky byly porovnány s výsledky získanými u kontrol. Studie 1. 20 pacientů s PN a 18 vázaných kontrol...Summary: The mechanisms of weight gain or behavioral and affective changes known to occur in patients with Parkinson's disease (PD) treated with deep brain stimulation of the subthalamic nucleus (STN DBS) are incompletely understood. We hypothesize that some of these non-motor side-effects may be related to changes in motivational processing due to STN DBS. Motivational processing to appetitive and aversive stimuli can be assessed using subjective evaluation of emotional relevance (i.e. incentive salience attribution) or affective modulation of the auditory blink reflex (ABR). The latter provides an objective measure of changes in emotional reactivity: ABRs are physiologically potentiated by unpleasant and inhibited by pleasant stimuli, reflecting activation of the aversive and appetitive motivational systems. Our aim was to assess the effects of STN DBS on motivational processing of pictures from 4 categories, two representing primary rewards, erotica and food, one aversive fearful and one neutral, using the subjective evaluation of motivational relevance (Study 1.) and the modulation of the ABR reactivity (Study 2.) in off-medicated PD patients with DBS switched ON and OFF. The results were compared with those obtained in healthy controls using the same paradigms. Study 1. Twenty PD patients in bilateral...Neurologická klinika 1. LF UK a VFNDepartment of Neurology First Faculty of Medicine and General University HospitalFirst Faculty of Medicine1. lékařská fakult

Investigating self-perception of emotion in individuals with non-epileptic seizures (NES)

Emotional processing difficulties are hypothesised to be involved in the aetiology and maintenance of non-epileptic seizures (NES). This thesis aimed to explore the relationship between aspects of emotional processing: interoception, alexithymia and executive functioning, in people with NES in comparison with healthy controls and to understand how people with NES experience their symptoms, live with their condition, and perceive the role of life events in relation to their seizures. Study 1 reviewed the evidence for a relationship between interoception and other key emotional factors in studies which employed heartbeat perception tasks to measure interoception. Study quality was found to be generally poor, with no consistent evidence for significant findings between interoception and emotional factors, including alexithymia, depression, and anxiety. Study 2 was a cross-sectional, online, study to investigate an interactional model of emotion processing, exploring relationships between interoceptive sensibility, alexithymia, and executive functioning (attentional bias) in NES participants and healthy controls. Measures included the Body Perception Questionnaire (BPQ-VSF), the Toronto Alexithymia Scale-20 (TAS-20) and the emotional Stroop task (eStroop). The NES group, compared to controls, reported higher BPQ-VSF and TAS-20 scores. There were no significant correlations between any of the measures of interest in either the NES or control group. There was no evidence to support the proposed model. Study 3 was a qualitative study using Interpretative Phenomenological Analysis to explore: how individuals with NES respond emotionally to recent life events; and how these events impact on seizures. Six themes were developed from the analysis which described how NES affected many aspects of people’s lives. Four models captured the different ways in which people perceived the relationship between life stressors, their emotional responses, and their seizures: event->emotional response-> seizure; event-> emotional response -x-> no seizure; no event ->emotional reaction/experience -> seizure; and no event -x->no emotional response->seizure