title: Dopamine dysregulation syndrome, impulse control disorders and punding after deep brain stimulation surgery for Parkinson's disease.
abstract: Data regarding the effect of deep brain stimulation (DBS) surgery on the dopamine dysregulation syndrome (DDS), impulse control disorders (ICDs) and punding in Parkinson's disease (PD) are limited. We present a case series of 21 operated PD patients who had exhibited DDS, ICDs or punding at some stage during the disease. DDS remained unimproved or worsened post-operatively in 12/17 patients with pre-operative DDS (71%) (nine bilateral subthalamic nucleus [STN], one right-sided STN, two bilateral globus pallidus internus [GPi] DBS). DDS improved or resolved after bilateral STN DBS in 5/17 patients with pre-operative DDS. DDS apparently developed for the first time after bilateral STN DBS in two patients, although only after a latency of eight years in one case. One patient without reported pre-operative DDS or ICDs developed pathological gambling post-STN DBS. One patient had pathological gambling which resolved pre-operatively, and did not recur post-DBS. Thus, DDS, ICDs and punding may persist, worsen or develop for the first time after DBS surgery, although a minority of patients improved dramatically. Predictive factors may include physician vigilance, motor outcome and patient compliance.
authors: Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
authors: Shen-Yang
authors: SY
authors: Lim
authors: Sean S
authors: SS
authors: O'Sullivan
authors: Katya
authors: K
authors: Kotschet
authors: David A
authors: DA
authors: Gallagher
authors: Cameron
authors: C
authors: Lacey
authors: Andrew D
authors: AD
authors: Lawrence
authors: Andrew J
authors: AJ
authors: Lees
authors: Dudley J
authors: DJ
authors: O'Sullivan
authors: Richard F
authors: RF
authors: Peppard
authors: Julian P
authors: JP
authors: Rodrigues
authors: Anette
authors: A
authors: Schrag
authors: Paul
authors: P
authors: Silberstein
authors: Stephen
authors: S
authors: Tisch
authors: Andrew H
authors: AH
authors: Evans
mesh_terms: D000293:Adolescent; D000328:Adult; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000209:etiology* / Q000523:psychology*; D004298:Dopamine / Q000378:metabolism / Q000502:physiology*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology / Q000523:psychology; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology / Q000601:surgery*; D010349:Patient Compliance; D011183:Postoperative Complications / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004298:Dopamine