title: Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson's disease.
abstract: BACKGROUND
  Behavioural disorders associated with compulsive use of dopaminergic drugs for Parkinson's disease (PD) such as dopamine dysregulation syndrome (DDS) and impulse control disorders (ICDs) may have devastating consequences and are challenging to manage. Whether or not such patients should undergo subthalamic nucleus (STN) deep brain stimulation (DBS) is controversial. A few case reports and small series have reported contrasting effects of STN DBS on dopamine misuse and ICDs, while a recent prospective study found clear beneficial effects of STN DBS on these disorders.
  
  
  METHODS
  We conducted an observational study on 110 consecutive parkinsonian patients scheduled for STN DBS surgery. Patients were assessed preoperatively through extensive behavioural and psychiatric evaluations and divided into two groups: with or without compulsive dopaminergic medication use. Evaluations were repeated 1 year after surgery in both groups.
  
  
  RESULTS
  Before surgery 18 patients (16.3%) were compulsive dopamine users of whom 12 (10.9%) fulfilled all criteria for DDS. 90% of these patients also had at least one ICD compared to 20% in the group without compulsive dopamine use. One year after surgery, one patient had persistent compulsive dopamine use, while no new occurrences were reported in the group without the condition before surgery. STN DBS did not provoke any major psychiatric complications and ICDs were reduced in all patients.
  
  
  CONCLUSIONS
  Our results suggest that STN DBS may reduce compulsive use of dopaminergic medication and its behavioural consequences. Whether this improvement is the result of STN DBS or the consequence of better treatment management remains to be established.
authors: Department of Neurology and Movement Disorders, CHU Timone, APHM, 264 rue Saint-Pierre, 13385 Marseille Cedex 05, France. alexandre.eusebio@ap-hm.fr
authors: Alexandre
authors: A
authors: Eusebio
authors: Tatiana
authors: T
authors: Witjas
authors: Julien
authors: J
authors: Cohen
authors: Frédérique
authors: F
authors: Fluchère
authors: Elisabeth
authors: E
authors: Jouve
authors: Jean
authors: J
authors: Régis
authors: Jean-Philippe
authors: JP
authors: Azulay
mesh_terms: D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D056912:Binge-Eating Disorder / Q000209:etiology; D003192:Compulsive Behavior / Q000523:psychology*; D046690:Deep Brain Stimulation; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000523:psychology; D015259:Dopamine Agents / Q000627:therapeutic use*; D004567:Electrodes, Implanted; D005260:Female; D005715:Gambling / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D019635:Neurosurgical Procedures; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000523:psychology*; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000978:Antiparkinson Agents; D015259:Dopamine Agents
keywords: BEHAVIOURAL DISORDER; MOVEMENT DISORDERS; PARKINSON'S DISEASE; STEREOTAXIC SURGERY