Influences of dopaminergic and subthalamic stimulation on pupil response during emotional processing in Parkinson's disease

1. Sánchez-Fernández, F. Luis
2. Sanmartino, Florencia
3. Méndez-Bértolo, Constantino
4. López-Sosa, Fernando
5. Cruz-Gómez, Álvaro J.
6. Lozano-Soto, Elena
7. Macías-García, Paloma
8. Riqué, Jesús
9. Espinosa-Rosso, Raúl
10. Rashid-López, Raúl
11. González-Rosa, Javier J.

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DOI: 10.1016/J.BRS.2023.01.693 GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Brain Stimulation

Resumen

Background: Studies concerning contributions of the basal ganglia to pupil response facilitation during explicit and implicit emotional processing in Parkinson’s disease (PD) are scarce. Here we investigated the effects of levodopa and subthalamic nucleus deep brain stimulation (SNT-DBS) on the relationship between phasic fluctuations in pupil diameter and emotional processing type in medicated and unmedicated PD patients during sequential sessions of STN-DBS ‘On/Off’.Methods: Participants were 13 STN-DBS ‘On-Off’ PD patients ‘Off’ dopaminergic medication, 14 PD patients ‘On’ dopaminergic medication, and 15 age-, gender- and education-matched healthy controls. STN-DBS patients performed the experimental session with STN-DBS ‘On’ and STN-DBS ‘Off’ in a randomized order. Participants’ initial constriction and later pupil dilation were recorded by an eye-tracker while viewing emotional scenes under varying explicit (emotional valence) and implicit (stimuli characteristic) attention demands.Results: STN-DBS ‘Off’ produced significantly different transient pupillary responses compared to STN-DBS ‘On’, ‘On’ medication PD patients, and the healthy group. Pupil constriction differences were particularly marked during ‘Off’ medication-STN-DBS ‘Off’ states. Comparing STN-DBS ‘On/Off’ and ‘On’ medication states, a significant initial contraction was detected between implicit and explicit emotional processing, while pupillary responses returned to normal followed by ‘On’ medication and STN stimulation despite ‘Off’ medication. Interestingly, no effects relative to late pupillary dilation responses were observed between experimental conditions despite ‘Off-Off’ states.Conclusions: These results suggest that STN-DBS modulates the response of the autonomic nervous system, reflected in the pupillary recovery to normal levels. These effects appear to work similarly to dopaminergic medication in PD patients. Remarkably, our results also show the role of STN in parasympathetic-dopaminergic function and its cortical influences when attention demands are manipulated. The pupillary response is a potentially useful psychophysiological marker that could be used in the online assessment of the symptomatic effects of levodopa and DBS therapies.