title: Effects of STN and GPi deep brain stimulation on impulse control disorders and dopamine dysregulation syndrome.
abstract: OBJECTIVE
  Impulse control disorders (ICDs) and dopamine dysregulation syndrome (DDS) are important behavioral problems that affect a subpopulation of patients with Parkinson's disease (PD) and typically result in markedly diminished quality of life for patients and their caregivers. We aimed to investigate the effects of subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) on ICD/DDS frequency and dopaminergic medication usage.
  
  
  METHODS
  A retrospective chart review was performed on 159 individuals who underwent unilateral or bilateral PD DBS surgery in either STN or GPi. According to published criteria, pre- and post-operative records were reviewed to categorize patients both pre- and post-operatively as having ICD, DDS, both ICD and DDS, or neither ICD nor DDS. Group differences in patient demographics, clinical presentations, levodopa equivalent dose (LED), and change in diagnosis following unilateral/bilateral by brain target (STN or GPi DBS placement) were examined.
  
  
  RESULTS
  28 patients met diagnostic criteria for ICD or DDS pre- or post-operatively. ICD or DDS classification did not differ by GPi or STN target stimulation. There was no change in DDS diagnosis after unilateral or bilateral stimulation. For ICD, diagnosis resolved in 2 of 7 individuals after unilateral or bilateral DBS. Post-operative development of these syndromes was significant; 17 patients developed ICD diagnoses post-operatively with 2 patients with pre-operative ICD developing DDS post-operatively.
  
  
  CONCLUSIONS
  Unilateral or bilateral DBS did not significantly treat DDS or ICD in our sample, even though a few cases of ICD resolved post-operatively. Rather, our study provides preliminary evidence that DDS and ICD diagnoses may emerge following DBS surgery.
authors.affiliation: Department of Neurology, Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Moum
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Price
authors.forename: Natlada
authors.initials: N
authors.lastname: Limotai
authors.forename: Genko
authors.initials: G
authors.lastname: Oyama
authors.forename: Herbert
authors.initials: H
authors.lastname: Ward
authors.forename: Charles
authors.initials: C
authors.lastname: Jacobson
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Foote
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation / Q000379:methods*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000150:complications / Q000628:therapy*; D004298:Dopamine / Q000378:metabolism*; D005260:Female; D005917:Globus Pallidus; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy; D012201:Reward; D020531:Subthalamic Nucleus
chemical_list: D004298:Dopamine