Impulse control and related disorders in Parkinson’s disease patients treated with bilateral subthalamic nucleus stimulation: A review

Broen, Martijn P. G.; Duits, Annelien; Visser‐Vandewalle, Veerle; Temel, Yasin; Winogrodzka, Ania

doi:10.1016/j.parkreldis.2011.02.013

Cited by 127 publications

(88 citation statements)

References 54 publications

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“…The possibility of induction of new onset ICD by STN-DBS has been already reported [22], even if other studies demonstrated an improvement of pre-existing ICD after DBS [23]. The central position of the STN within the basal ganglia thalamo-cortical associative and limbic circuits could explain its role in promoting the onset of ICD in some patients [24]; STN-DBS can indeed interfere with the response inhibition pattern, leading to an increase of impulsivity [25]. This finding further supports the necessity of a psychiatric surveillance of the patients after STN-DBS.…”

Section: Discussionmentioning

confidence: 97%

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Long-term outcome of subthalamic nucleus DBS in Parkinson's disease: From the advanced phase towards the late stage of the disease?

Rizzone

Fasano

Daniele

et al. 2014

Parkinsonism & Related Disorders

161

152

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Background: Deep Brain Stimulation of the Subthalamic Nucleus (STN-DBS) is an effective treatment for Parkinson's disease (PD), but only few studies investigated its long-term efficacy. Furthermore, little is known about the role of PD-subtype on STN-DBS long-term outcome.Objective: To report the results of a long-term follow-up (mean 11 years, range 10-13) on 26 patients bilaterally implanted in two centres. Methods:Patients were assessed preoperatively and 1, 5 and 11 years after the implant by the Unified Parkinson's Disease Rating Scale (UPDRS) and a battery of neuropsychological tests. Stimulation parameters, drugs dosages, non-motor symptoms and adverse events were also recorded.Results: At 11 years, stimulation significantly improved the motor symptoms by 35.8%, as compared to the preoperative off-state. Motor complications were well controlled, with a 84.6% improvement of dyskinesias and a 65.8% improvement of motor fluctuations. Despite this, the UPDRS-II-on score worsened by 88.5%, mainly for the worsening of poorly levodopa-responsive symptoms. More than 70% of the patients performed in the normal range in most of the neuropsychological tests, despite the development of dementia in 22.7%. Age at disease onset, axial subscore in off-condition and presence of REM behaviour disorder at baseline were found to be associated with a higher risk of developing disability over time. Conclusions:Our study confirms the long-term safety and efficacy of STN-DBS in PD. Nevertheless, the functionality of patients worsens over time, mainly for the onset and progression of levodopa-resistant and non-motor symptoms. The role of PD-subtype seems to be relevant in the long-term outcome.

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Section: Discussionmentioning

confidence: 97%

“…In addition to total score (items 18-31), specific subscores were taken into account: bradykinesia (items 19,[23][24][25][26]31), tremor (items 20-21), rigidity (item 22), speech (item 18), gait (item 29), postural stability (item 30) and axial score (items 18, 27-30).…”

Section: Motor Assessmentmentioning

confidence: 99%

Long-term outcome of subthalamic nucleus DBS in Parkinson's disease: From the advanced phase towards the late stage of the disease?

Rizzone

Fasano

Daniele

et al. 2014

Parkinsonism & Related Disorders

161

152

View full text Add to dashboard Cite

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“…Therefore, the excess occurrence of these disorders in PD is likely driven by exposure to PD pharmacotherapy and possibly other PD treatments (e.g., deep brain stimulation surgery 21 ), with certain clinical and demographic variables (e.g., younger age, family or personal history of similar behaviors 3,4 ) moderating an individual's risk for developing an ICD. It also supports recent case reporting of ICDs occurring with dopamine agonist treatment in other clinical populations (e.g., restless legs syndrome 22 and fibromyalgia 23 ).…”

mentioning

confidence: 99%

Screening for impulse control symptoms in patients with de novo Parkinson disease

Weintraub

Papay

Siderowf³

2013

Neurology

179

122

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Objective: To determine the frequency and correlates of impulse control and related behavior symptoms in patients with de novo, untreated Parkinson disease (PD) and healthy controls (HCs).Methods: The Parkinson's Progression Markers Initiative is an international, multisite, case-control clinical study conducted at 21 academic movement disorders centers. Participants were recently diagnosed, untreated PD patients (n 5 168) and HCs (n 5 143). The outcome measures were presence of current impulse control and related behavior symptoms based on recommended cutoff points for the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP)-Short Form.Results: There were 311 participants with complete QUIP data. Frequencies of impulse control and related behavior symptoms for patients with PD vs HCs were as follows: gambling (1.2% vs 0.7%), buying (3.0% vs 2.1%), sexual behavior (4.2% vs 3.5%), eating (7.1% vs 10.5%), punding (4.8% vs 2.1%), hobbyism (5.4% vs 11.9%), walkabout (0.6% vs 0.7%), and any impulse control or related behavior (18.5% vs 20.3%). In multivariable models, a diagnosis of PD was not associated with symptoms of any impulse control or related behavior (p $ 0.10 in all cases).Conclusions: PD itself does not seem to confer an increased risk for development of impulse control or related behavior symptoms, which further reinforces the reported association between PD medications and impulse control disorders in PD. Given that approximately 20% of patients with newly diagnosed PD report some impulse control or related behavior symptoms, long-term followup is needed to determine whether such patients are at increased risk for impulse control disorder development once PD medications are initiated. Impulse control disorders (ICDs), including compulsive gambling, buying, sexual behavior, and eating, are common and clinically significant in Parkinson disease (PD).1 Other compulsive behaviors reported to occur include punding (excessive repetition of non-goal directed activity), 2 hobbyism (excessive repetition of more complex activities), 3 and walkabout (aimless wandering).2 In a recent large observational study of patients with treated PD, an ICD was identified in 14% of patients. 4 Prevalence rates for punding range from 1% to 14%, 5,6 whereas the prevalence of hobbyism and walkabout are not known.The association between PD medications and ICDs in PD is well established. 4,7 However, an important unanswered question is whether PD itself confers an altered risk for ICDs. Preliminary comparison studies suggest that ICDs are more common in treated PD patients than in healthy controls (HCs). 8,9 In the only published study assessing newly diagnosed, untreated PD patients, 18% screened positive for impulse control symptoms, a number similar to HCs.

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“…3.5 Effects of deep brain stimulation of the subthalamic nucleus on impulse control disorders 3.5.1 Impulse control disorders: Clinical presentation, evolution, and pathophysiology In Parkinsonian patients treated by deep brain stimulation of the subthalamic nucleus, impulse control disorders (pathological gambling, hypersexuality, compulsive eating and buying/shopping) may occasionally appear after surgery, while in most cases preexisting impulse control disorders may improve or disappear after subthalamic implants (Broen et al, 2011;Witjas et al, 2005;Bandini et al, 2007;Ardouin et al, 2006;Lim et al, 2009). …”

Section: Psychotic Symptoms: Treatment and Prognosismentioning

confidence: 99%

Cognitive and Behavioural Changes After Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease

Daniele¹,

Spinelli²,

Piccininni³

2012

Explicative Cases of Controversial Issues in Neurosurgery

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Impulse control and related disorders in Parkinson’s disease patients treated with bilateral subthalamic nucleus stimulation: A review

Cited by 127 publications

References 54 publications

Long-term outcome of subthalamic nucleus DBS in Parkinson's disease: From the advanced phase towards the late stage of the disease?

Long-term outcome of subthalamic nucleus DBS in Parkinson's disease: From the advanced phase towards the late stage of the disease?

Screening for impulse control symptoms in patients with de novo Parkinson disease

Cognitive and Behavioural Changes After Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease

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