title: Deep brain stimulation and behavioural changes: is comedication the most important factor?
abstract: BACKGROUND
  Adverse effects of dopaminergic medication (DA; levodopa and dopamine agonists) on impulsive behaviour and decision-making in patients with Parkinson's disease (PD) have been repeatedly reported. Deep brain stimulation (DBS) is increasingly used for the treatment of parkinsonian motor symptoms, but the excellent efficacy of DBS contrasts with a growing number of reports that the treatment may result in behavioural complications.
  
  
  OBJECTIVE
  We investigated impulsive behaviour under different therapeutic treatments.
  
  
  METHODS
  Fifteen patients with PD with DBS (PD-DBS) were assessed with electrical stimulation switched on and off, respectively. Data were compared with those of 15 patients with PD without DBS implantation under DA medication (PD-DA), matched for age and disease duration. Impulsive behaviour (gambling performance) was measured together with neuropsychological assessments regarding depression, current mood and cognitive performance.
  
  
  RESULTS
  PD-DA patients performed worse in the gambling task than DBS patients with electrical stimulation turned off. A significant interaction of performance and medication was observed. When DBS was turned on, the differences in performance were less pronounced.
  
  
  CONCLUSIONS
  For gambling performance, the medication dose mainly explains differences in impulsive behaviour. Although DBS had a minor negative effect on impulsive behaviour, the positive effect of a reduced DA dosis after DBS might reduce impulse control abnormalities.
authors.affiliation: Department of Neurology, University of Ulm, Germany. dorothee.lule @ uni-ulm.de
authors.forename: Dorothée
authors.initials: D
authors.lastname: Lulé
authors.forename: Johanna
authors.initials: J
authors.lastname: Heimrath
authors.forename: Elmar H
authors.initials: EH
authors.lastname: Pinkhardt
authors.forename: Albert C
authors.initials: AC
authors.lastname: Ludolph
authors.forename: Ingo
authors.initials: I
authors.lastname: Uttner
authors.forename: Jan
authors.initials: J
authors.lastname: Kassubek
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects*; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D005260:Female; D005715:Gambling / Q000209:etiology*; D006801:Humans; D007175:Impulsive Behavior / Q000209:etiology*; D007980:Levodopa / Q000009:adverse effects*; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000628:therapy*; D012309:Risk-Taking; D020531:Subthalamic Nucleus
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa