title: Impulse control behaviors and subthalamic deep brain stimulation in Parkinson disease.
abstract: To determine the clinical and demographic correlates of persistent, remitting, and new-onset impulse control behaviors (ICBs) before and after subthalamic deep brain stimulation (STN-DBS) in Parkinson's disease (PD). We compared the pre- and post-surgical prevalence of ICBs, classified as impulse control disorders (ICD), dopamine dysregulation syndrome (DDS), and punding in 150 consecutive PD STN-DBS-treated patients and determined the association with motor, cognitive, neuropsychological, and neuropsychiatric endpoints. At baseline (before STN-DBS), ICBs were associated with younger age (p = 0.045) and male gender (85 %; p = 0.001). Over an average follow-up of 4.3 ± 2.1 years of chronic STN-DBS there was an overall trend for reduction in ICBs (from 17.3 to 12.7 %; p = 0.095) with significant improvement in hypersexuality (12-8.0 %; p = 0.047), gambling (10.7-5.3 %; p = 0.033), and DDS (4.7-0 %; p < 0.001). ICB remitted in 18/26 patients (69 %) and persisted in 8/26 (31 %); the latter group was characterized by higher levodopa equivalent daily dose. Patients who developed a new-onset ICB during follow-up (n = 11/150) were characterized by younger age (p = 0.042), lower dyskinesia improvement (p ≤ 0.035), and a gender distribution with higher prevalence of women (p = 0.018). In addition, new-onset ICB was more common among patients with borderline, schizoid, and/or schizotypal traits of personality disorders; persistent ICB in those with obsessive-compulsive traits. PD-related ICBs exhibit a complex outcome after STN-DBS, with a tendency for overall reduction but with age, gender, dopaminergic therapy, and neuropsychiatric features exerting independent effects.
authors.affiliation: Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati (UC), 260 Stetson Street, Suite 4244, Cincinnati, OH, 45219, USA. merolaae@ucmail.uc.edu.
authors.forename: Aristide
authors.identifier: http://orcid.org/0000-0002-5587-726X
authors.initials: A
authors.lastname: Merola
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Turin, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Romagnolo
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Turin, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Rizzi
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Turin, Italy.
authors.forename: Mario Giorgio
authors.initials: MG
authors.lastname: Rizzone
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Turin, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zibetti
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Turin, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Lanotte
authors.affiliation: Department of Neurosurgery, Neuroscience Institute and UC College of Medicine, University of Cincinnati (UC), Cincinnati, OH, USA.
authors.forename: George
authors.initials: G
authors.lastname: Mandybur
authors.affiliation: Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati (UC), 260 Stetson Street, Suite 4244, Cincinnati, OH, 45219, USA.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Duker
authors.affiliation: Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati (UC), 260 Stetson Street, Suite 4244, Cincinnati, OH, 45219, USA.
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Espay
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Turin, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lopiano
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D015995:Prevalence; D012737:Sex Factors; D020531:Subthalamic Nucleus / Q000503:physiopathology; D016896:Treatment Outcome
keywords: Electrical stimulation; Impulse control behaviors; Neurosurgery; Parkinson’s disease; Personality