Effects of STN and GPi deep brain stimulation on impulse control disorders and dopamine dysregulation syndrome.

Natlada Limotai,Kelly D Foote,Herbert Ward,Sarah J Moum,Genko Oyama,Celia Oreja-Guevara,Catherine C Price,Charles Jacobson,Michael S Okun

doi:10.1371/journal.pone.0029768

Natlada Limotai, Kelly D Foote + Show 7 more

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https://doi.org/10.1371/journal.pone.0029768

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Abstract

ObjectiveImpulse control disorders (ICDs) and dopamine dysregulation syndrome (DDS) are important behavioral problems that affect a subpopulation of patients with Parkinson's disease (PD) and typically result in markedly diminished quality of life for patients and their caregivers. We aimed to investigate the effects of subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) on ICD/DDS frequency and dopaminergic medication usage.MethodsA retrospective chart review was performed on 159 individuals who underwent unilateral or bilateral PD DBS surgery in either STN or GPi. According to published criteria, pre- and post-operative records were reviewed to categorize patients both pre- and post-operatively as having ICD, DDS, both ICD and DDS, or neither ICD nor DDS. Group differences in patient demographics, clinical presentations, levodopa equivalent dose (LED), and change in diagnosis following unilateral/bilateral by brain target (STN or GPi DBS placement) were examined.Results28 patients met diagnostic criteria for ICD or DDS pre- or post-operatively. ICD or DDS classification did not differ by GPi or STN target stimulation. There was no change in DDS diagnosis after unilateral or bilateral stimulation. For ICD, diagnosis resolved in 2 of 7 individuals after unilateral or bilateral DBS. Post-operative development of these syndromes was significant; 17 patients developed ICD diagnoses post-operatively with 2 patients with pre-operative ICD developing DDS post-operatively.ConclusionsUnilateral or bilateral DBS did not significantly treat DDS or ICD in our sample, even though a few cases of ICD resolved post-operatively. Rather, our study provides preliminary evidence that DDS and ICD diagnoses may emerge following DBS surgery.

Highlights

Dopamine agonist therapy and sometimes even levodopa therapy for Parkinson’s disease (PD) may be associated with hypersexuality, pathological gambling, compulsive eating, compulsive shopping, and other Impulse control disorders (ICDs) [1]
In PD patients dopamine replacement therapy may result in a pathological overusage of levodopa [2] and this condition has been termed the dopamine dysregulation syndrome (DDS) [3,4,5]
The effects of subthalamic nucleus (STN) and/or globus pallidus (GPi) deep brain stimulation (DBS) on these issues remains largely unknown, many groups have argued that DBS, in the STN, may be beneficial for these syndromes by facilitating dopamine agonist and levodopa reduction [6,7]

Summary

Introduction

Dopamine agonist therapy and sometimes even levodopa therapy for Parkinson’s disease (PD) may be associated with hypersexuality, pathological gambling, compulsive eating, compulsive shopping, and other ICDs [1]. In PD patients dopamine replacement therapy may result in a pathological overusage of levodopa [2] and this condition has been termed the dopamine dysregulation syndrome (DDS) [3,4,5]. Patients with earlier onset PD have been observed to experience more severe motor fluctuations and to have a higher propensity to develop ICDs and DDS [11,12]. These patients are more likely to be included in DBS cohorts [13]

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