title: Pathological gambling in Parkinson's disease: subthalamic oscillations during economics decisions.
abstract: Pathological gambling develops in up to 8% of patients with Parkinson's disease. Although the pathophysiology of gambling remains unclear, several findings argue for a dysfunction in the basal ganglia circuits. To clarify the role of the subthalamic nucleus in pathological gambling, we studied its activity during economics decisions. We analyzed local field potentials recorded from deep brain stimulation electrodes in the subthalamic nucleus while parkinsonian patients with (n = 8) and without (n = 9) pathological gambling engaged in an economics decision-making task comprising conflictual trials (involving possible risk-taking) and non conflictual trials. In all parkinsonian patients, subthalamic low frequencies (2-12 Hz) increased during economics decisions. Whereas, in patients without gambling, low-frequency oscillations exhibited a similar pattern during conflictual and non conflictual stimuli, in those with gambling, low-frequency activity increased significantly more during conflictual than during non conflictual stimuli. The specific low-frequency oscillatory pattern recorded in patients with Parkinson's disease who gamble could reflect a subthalamic dysfunction that makes their decisional threshold highly sensitive to risky options. When parkinsonian patients process stimuli related to an economics task, low-frequency subthalamic activity increases. This task-related change suggests that the cognitive-affective system that drives economics decisional processes includes the subthalamic nucleus. The specific subthalamic neuronal activity during conflictual decisions in patients with pathological gambling supports the idea that the subthalamic nucleus is involved in behavioral strategies and in the pathophysiology of gambling.
authors.affiliation: Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Rosa
authors.forename: Manuela
authors.initials: M
authors.lastname: Fumagalli
authors.forename: Gaia
authors.initials: G
authors.lastname: Giannicola
authors.forename: Sara
authors.initials: S
authors.lastname: Marceglia
authors.forename: Claudio
authors.initials: C
authors.lastname: Lucchiari
authors.forename: Domenico
authors.initials: D
authors.lastname: Servello
authors.forename: Angelo
authors.initials: A
authors.lastname: Franzini
authors.forename: Claudio
authors.initials: C
authors.lastname: Pacchetti
authors.forename: Luigi
authors.initials: L
authors.lastname: Romito
authors.forename: Alberto
authors.initials: A
authors.lastname: Albanese
authors.forename: Mauro
authors.initials: M
authors.lastname: Porta
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pravettoni
authors.forename: Alberto
authors.initials: A
authors.lastname: Priori
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making / Q000502:physiology*; D046690:Deep Brain Stimulation; D004567:Electrodes, Implanted; D005260:Female; D005715:Gambling / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D008297:Male; D008564:Membrane Potentials / Q000502:physiology*; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D012309:Risk-Taking; D020531:Subthalamic Nucleus / Q000503:physiopathology*
keywords: Parkinson's disease; decision-making; local field potentials; pathological gambling; subthalamic nucleus