title: Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation.
abstract: Pathological gambling (PG) related to dopaminergic treatment in Parkinson's disease (PD) is part of a spectrum of behavioral disorders called the dopamine dysregulation syndrome (DDS). We describe a series of PD patients with preoperative active PG due to dopaminergic treatment from a total of 598 patients who have undergone surgery for subthalamic nucleus stimulation for disabling motor fluctuations. The patients had systematic open assessment of behavioral symptoms and standardized assessments of motor symptoms, mood, and apathy. Seven patients (6 men, 1 woman; age, 54 +/- 9 years; levodopa equivalent dose, 1,390 +/- 350 mg/day) had preoperative PG over a mean of 7 years, intolerant to reduction in medication. Six had nonmotor fluctuations and four had other behavioral symptoms consistent with a diagnosis of the DDS. After surgery, motor symptoms improved, allowing for 74% reduction of dopaminergic treatment, below the dosage of gambling onset. In all patients, PG resolved postoperatively after 18 months on average (range, 0-48), although transient worsening occurred in two. Improvement paralleled the time course and degree of reduction in dopaminergic treatment. Nonmotor fluctuations, off period dysphoria, and other symptoms of the DDS improved. Two patients developed persistent apathy. In conclusion, PG and other symptoms of the DDS-associated dopaminergic treatment improved in our patients following surgery. Dopaminergic dysregulation commonly attributed to pulsatile overstimulation of the limbic dopaminergic system may be subject to desensitization on chronic subthalamic stimulation, which has a relative motor selectivity and allows for decrease in dopaminergic treatment.
authors.affiliation: Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Ardouin
authors.forename: Valerie
authors.initials: V
authors.lastname: Voon
authors.forename: Yulia
authors.initials: Y
authors.lastname: Worbe
authors.forename: Nehman
authors.initials: N
authors.lastname: Abouazar
authors.forename: Virginie
authors.initials: V
authors.lastname: Czernecki
authors.forename: Hassan
authors.initials: H
authors.lastname: Hosseini
authors.forename: Antoine
authors.initials: A
authors.lastname: Pelissolo
authors.forename: Elena
authors.initials: E
authors.lastname: Moro
authors.forename: Eugénie
authors.initials: E
authors.lastname: Lhommée
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Lang
authors.forename: Yves
authors.initials: Y
authors.lastname: Agid
authors.forename: Alim-Louis
authors.initials: AL
authors.lastname: Benabid
authors.forename: Pierre
authors.initials: P
authors.lastname: Pollak
authors.forename: Luc
authors.initials: L
authors.lastname: Mallet
authors.forename: Paul
authors.initials: P
authors.lastname: Krack
mesh_terms: D000328:Adult; D004307:Dose-Response Relationship, Radiation; D004599:Electric Stimulation Therapy; D005260:Female; D005500:Follow-Up Studies; D005715:Gambling; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010300:Parkinson Disease / Q000473:pathology / Q000523:psychology / Q000601:surgery; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000503:physiopathology / Q000528:radiation effects*