Rapid resolution of dopamine dysregulation syndrome (DDS) after subthalamic DBS for Parkinson disease (PD): a case report.
OBJECTIVE
To describe how subthalamic deep brain stimulation (STN-DBS) and reduction in dopamine replacement therapy (DRT) allowed rapid resolution of dopamine dysregulation syndrome (DDS) with severe behavioral disorder in a patient with late stage Parkinson disease (PD).


BACKGROUND
DDS was recently defined as compulsive use of dopaminergic drugs, associated with severe behavioral symptoms, and impaired social functioning, occurring in about 4% of PD patients under DRT. STN-DBS is an effective treatment for late stage PD with treatment resistant motor fluctuations, which frequently allows also to reduce DRT.


METHODS
A late stage PD patient referred to our center for STN-DBS, suffering from severe DDS necessitating in-ward psychiatric management, was comprehensively assessed preoperatively and postoperatively for motor, cognitive, and psychiatric status.


RESULTS
Following subthalamic DBS procedure and medication reduction, we observed a rapid and dramatic resolution of DDS and associated psychiatric symptoms, allowing discharge from a 2-year stay in a psychiatric institution.


CONCLUSIONS
DDS occurring in late stage PD patients may be dramatically improved by STN-DBS, possibly in relation with the reduction of dopaminergic medication. In contrast to other psychiatric symptoms, DDS should not be considered as an obstacle to DBS procedure in late stage PD patients.
Knobel
David
D
Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
Aybek
Selma
S
Pollo
Claudio
C
Vingerhoets
François J G
FJ
Berney
Alexandre
A
D000374:Aggression / Q000523:psychology; D000978:Antiparkinson Agents / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000379:methods*; D004298:Dopamine / Q000502:physiology*; D006801:Humans; D007175:Impulsive Behavior / Q000523:psychology; D007211:Indoles / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D020531:Subthalamic Nucleus / Q000502:physiology*; D011795:Surveys and Questionnaires
D000978:Antiparkinson Agents; D007211:Indoles; C046649:ropinirole; D004298:Dopamine