Journal of neurology, 2017-01, Vol.264 (1), p.40-48
To determine the clinical and demographic correlates of persistent, remitting, and new-onset impulse control behaviors (ICBs) before and after subthalamic deep brain stimulation (STN-DBS) in Parkinson’s disease (PD). We compared the pre- and post-surgical prevalence of ICBs, classified as impulse control disorders (ICD), dopamine dysregulation syndrome (DDS), and punding in 150 consecutive PD STN-DBS-treated patients and determined the association with motor, cognitive, neuropsychological, and neuropsychiatric endpoints. At baseline (before STN-DBS), ICBs were associated with younger age (p = 0.045) and male gender (85 %; p = 0.001). Over an average follow-up of 4.3 ± 2.1 years of chronic STN-DBS there was an overall trend for reduction in ICBs (from 17.3 to 12.7 %; p = 0.095) with significant improvement in hypersexuality (12–8.0 %; p = 0.047), gambling (10.7–5.3 %; p = 0.033), and DDS (4.7–0 %; p 〈 0.001). ICB remitted in 18/26 patients (69 %) and persisted in 8/26 (31 %); the latter group was characterized by higher levodopa equivalent daily dose. Patients who developed a new-onset ICB during follow-up (n = 11/150) were characterized by younger age (p = 0.042), lower dyskinesia improvement (p ≤ 0.035), and a gender distribution with higher prevalence of women (p = 0.018). In addition, new-onset ICB was more common among patients with borderline, schizoid, and/or schizotypal traits of personality disorders; persistent ICB in those with obsessive–compulsive traits. PD-related ICBs exhibit a complex outcome after STN-DBS, with a tendency for overall reduction but with age, gender, dopaminergic therapy, and neuropsychiatric features exerting independent effects.
Neurology ; Neurosciences ; Medicine & Public Health ; Electrical stimulation ; Personality ; Neurosurgery ; Impulse control behaviors ; Neuroradiology ; Parkinson’s disease ; Parkinson Disease - therapy ; Prevalence ; Age Factors ; Follow-Up Studies ; Subthalamic Nucleus - physiopathology ; Humans ; Middle Aged ; Disruptive, Impulse Control, and Conduct Disorders - etiology ; Male ; Treatment Outcome ; Deep Brain Stimulation - adverse effects ; Parkinson Disease - physiopathology ; Parkinson Disease - psychology ; Disruptive, Impulse Control, and Conduct Disorders - therapy ; Disruptive, Impulse Control, and Conduct Disorders - physiopathology ; Neuropsychological Tests ; Disruptive, Impulse Control, and Conduct Disorders - epidemiology ; Sex Factors ; Parkinson Disease - epidemiology ; Adult ; Female ; Aged ; Longitudinal Studies ; Care and treatment ; Parkinson's disease ; Research ; Brain stimulation ; Health aspects ; Index Medicus
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