Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation
Identifieur interne : 000856 ( Istex/Corpus ); précédent : 000855; suivant : 000857Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation
Auteurs : Claire Ardouin ; Valerie Voon ; Yulia Worbe ; Nehman Abouazar ; Virginie Czernecki ; Hassan Hosseini ; Antoine Pelissolo ; Elena Moro ; Eugénie Lhommée ; Anthony E. Lang ; Yves Agid ; Alim-Louis Benabid ; Pierre Pollak ; Luc Mallet ; Paul KrackSource :
- Movement Disorders [ 0885-3185 ] ; 2006-11.
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Abstract
Pathological gambling (PG) related to dopaminergic treatment in Parkinson's disease (PD) is part of a spectrum of behavioral disorders called the dopamine dysregulation syndrome (DDS). We describe a series of PD patients with preoperative active PG due to dopaminergic treatment from a total of 598 patients who have undergone surgery for subthalamic nucleus stimulation for disabling motor fluctuations. The patients had systematic open assessment of behavioral symptoms and standardized assessments of motor symptoms, mood, and apathy. Seven patients (6 men, 1 woman; age, 54 ± 9 years; levodopa equivalent dose, 1,390 ± 350 mg/day) had preoperative PG over a mean of 7 years, intolerant to reduction in medication. Six had nonmotor fluctuations and four had other behavioral symptoms consistent with a diagnosis of the DDS. After surgery, motor symptoms improved, allowing for 74% reduction of dopaminergic treatment, below the dosage of gambling onset. In all patients, PG resolved postoperatively after 18 months on average (range, 0–48), although transient worsening occurred in two. Improvement paralleled the time course and degree of reduction in dopaminergic treatment. Nonmotor fluctuations, off period dysphoria, and other symptoms of the DDS improved. Two patients developed persistent apathy. In conclusion, PG and other symptoms of the DDS‐associated dopaminergic treatment improved in our patients following surgery. Dopaminergic dysregulation commonly attributed to pulsatile overstimulation of the limbic dopaminergic system may be subject to desensitization on chronic subthalamic stimulation, which has a relative motor selectivity and allows for decrease in dopaminergic treatment. © 2006 Movement Disorder Society
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DOI: 10.1002/mds.21098
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type="doi">10.1002/mds.21098</idno><idno type="url">https://api.istex.fr/document/01E1178997AFF59E81BCB9E16F08C203E1942AC9/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000856</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation</title><author><name sortKey="Ardouin, Claire" sort="Ardouin, Claire" uniqKey="Ardouin C" first="Claire" last="Ardouin">Claire Ardouin</name><affiliation><mods:affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Voon, Valerie" sort="Voon, Valerie" uniqKey="Voon V" first="Valerie" last="Voon">Valerie Voon</name><affiliation><mods:affiliation>Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Worbe, Yulia" sort="Worbe, Yulia" uniqKey="Worbe Y" first="Yulia" last="Worbe">Yulia Worbe</name><affiliation><mods:affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Abouazar, Nehman" sort="Abouazar, Nehman" uniqKey="Abouazar N" first="Nehman" last="Abouazar">Nehman Abouazar</name><affiliation><mods:affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Czernecki, Virginie" sort="Czernecki, Virginie" uniqKey="Czernecki V" first="Virginie" last="Czernecki">Virginie Czernecki</name><affiliation><mods:affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Hosseini, Hassan" sort="Hosseini, Hassan" uniqKey="Hosseini H" first="Hassan" last="Hosseini">Hassan Hosseini</name><affiliation><mods:affiliation>Service de Neurologie, Hôpital Henri Mondor, Créteil, France</mods:affiliation></affiliation></author><author><name sortKey="Pelissolo, Antoine" sort="Pelissolo, Antoine" uniqKey="Pelissolo A" first="Antoine" last="Pelissolo">Antoine Pelissolo</name><affiliation><mods:affiliation>Psychiatrie UMR7593, Pitié‐ Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation><mods:affiliation>Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Lhommee, Eugenie" sort="Lhommee, Eugenie" uniqKey="Lhommee E" first="Eugénie" last="Lhommée">Eugénie Lhommée</name><affiliation><mods:affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name><affiliation><mods:affiliation>Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Agid, Yves" sort="Agid, Yves" uniqKey="Agid Y" first="Yves" last="Agid">Yves Agid</name><affiliation><mods:affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Benabid, Alim Ouis" sort="Benabid, Alim Ouis" uniqKey="Benabid A" first="Alim-Louis" last="Benabid">Alim-Louis Benabid</name><affiliation><mods:affiliation>Service de Neurochirurgie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name><affiliation><mods:affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Mallet, Luc" sort="Mallet, Luc" uniqKey="Mallet L" first="Luc" last="Mallet">Luc Mallet</name><affiliation><mods:affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</mods:affiliation></affiliation><affiliation><mods:affiliation>Psychiatrie UMR7593, Pitié‐ Salpêtrière, Paris, France</mods:affiliation></affiliation></author><author><name sortKey="Krack, Paul" sort="Krack, Paul" uniqKey="Krack P" first="Paul" last="Krack">Paul Krack</name><affiliation><mods:affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Movement Disorders</title><title level="j" type="sub">Official Journal of the Movement Disorder Society</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2006-11">2006-11</date><biblScope unit="vol">21</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1941">1941</biblScope><biblScope unit="page" to="1946">1946</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">01E1178997AFF59E81BCB9E16F08C203E1942AC9</idno><idno type="DOI">10.1002/mds.21098</idno><idno type="ArticleID">MDS21098</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Parkinson's disease</term><term>deep brain stimulation</term><term>dopamine</term><term>pathological gambling</term><term>subthalamic nucleus</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Pathological gambling (PG) related to dopaminergic treatment in Parkinson's disease (PD) is part of a spectrum of behavioral disorders called the dopamine dysregulation syndrome (DDS). We describe a series of PD patients with preoperative active PG due to dopaminergic treatment from a total of 598 patients who have undergone surgery for subthalamic nucleus stimulation for disabling motor fluctuations. The patients had systematic open assessment of behavioral symptoms and standardized assessments of motor symptoms, mood, and apathy. Seven patients (6 men, 1 woman; age, 54 ± 9 years; levodopa equivalent dose, 1,390 ± 350 mg/day) had preoperative PG over a mean of 7 years, intolerant to reduction in medication. Six had nonmotor fluctuations and four had other behavioral symptoms consistent with a diagnosis of the DDS. After surgery, motor symptoms improved, allowing for 74% reduction of dopaminergic treatment, below the dosage of gambling onset. In all patients, PG resolved postoperatively after 18 months on average (range, 0–48), although transient worsening occurred in two. Improvement paralleled the time course and degree of reduction in dopaminergic treatment. Nonmotor fluctuations, off period dysphoria, and other symptoms of the DDS improved. Two patients developed persistent apathy. In conclusion, PG and other symptoms of the DDS‐associated dopaminergic treatment improved in our patients following surgery. Dopaminergic dysregulation commonly attributed to pulsatile overstimulation of the limbic dopaminergic system may be subject to desensitization on chronic subthalamic stimulation, which has a relative motor selectivity and allows for decrease in dopaminergic treatment. © 2006 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Claire Ardouin MA</name><affiliations><json:string>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</json:string></affiliations></json:item><json:item><name>Valerie Voon MD</name><affiliations><json:string>Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Yulia Worbe MD</name><affiliations><json:string>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</json:string></affiliations></json:item><json:item><name>Nehman Abouazar MD</name><affiliations><json:string>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</json:string></affiliations></json:item><json:item><name>Virginie Czernecki MA</name><affiliations><json:string>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</json:string></affiliations></json:item><json:item><name>Hassan Hosseini MD</name><affiliations><json:string>Service de Neurologie, Hôpital Henri Mondor, Créteil, France</json:string></affiliations></json:item><json:item><name>Antoine Pelissolo MD</name><affiliations><json:string>Psychiatrie UMR7593, Pitié‐ Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>Elena Moro MD</name><affiliations><json:string>Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Eugénie Lhommée MA</name><affiliations><json:string>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</json:string></affiliations></json:item><json:item><name>Anthony E. Lang MD</name><affiliations><json:string>Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Yves Agid MD</name><affiliations><json:string>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</json:string></affiliations></json:item><json:item><name>Alim‐Louis Benabid MD</name><affiliations><json:string>Service de Neurochirurgie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</json:string></affiliations></json:item><json:item><name>Pierre Pollak MD</name><affiliations><json:string>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</json:string></affiliations></json:item><json:item><name>Luc Mallet MD</name><affiliations><json:string>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</json:string><json:string>Psychiatrie UMR7593, Pitié‐ Salpêtrière, Paris, France</json:string></affiliations></json:item><json:item><name>Paul Krack MD</name><affiliations><json:string>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>deep brain stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>pathological gambling</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>dopamine</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>subthalamic nucleus</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Pathological gambling (PG) related to dopaminergic treatment in Parkinson's disease (PD) is part of a spectrum of behavioral disorders called the dopamine dysregulation syndrome (DDS). We describe a series of PD patients with preoperative active PG due to dopaminergic treatment from a total of 598 patients who have undergone surgery for subthalamic nucleus stimulation for disabling motor fluctuations. The patients had systematic open assessment of behavioral symptoms and standardized assessments of motor symptoms, mood, and apathy. Seven patients (6 men, 1 woman; age, 54 ± 9 years; levodopa equivalent dose, 1,390 ± 350 mg/day) had preoperative PG over a mean of 7 years, intolerant to reduction in medication. Six had nonmotor fluctuations and four had other behavioral symptoms consistent with a diagnosis of the DDS. After surgery, motor symptoms improved, allowing for 74% reduction of dopaminergic treatment, below the dosage of gambling onset. In all patients, PG resolved postoperatively after 18 months on average (range, 0–48), although transient worsening occurred in two. Improvement paralleled the time course and degree of reduction in dopaminergic treatment. Nonmotor fluctuations, off period dysphoria, and other symptoms of the DDS improved. Two patients developed persistent apathy. In conclusion, PG and other symptoms of the DDS‐associated dopaminergic treatment improved in our patients following surgery. Dopaminergic dysregulation commonly attributed to pulsatile overstimulation of the limbic dopaminergic system may be subject to desensitization on chronic subthalamic stimulation, which has a relative motor selectivity and allows for decrease in dopaminergic treatment. © 2006 Movement Disorder Society</abstract><qualityIndicators><score>7.241</score><pdfVersion>1.3</pdfVersion><pdfPageSize>594 x 792 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>1735</abstractCharCount><pdfWordCount>4277</pdfWordCount><pdfCharCount>27813</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>247</abstractWordCount></qualityIndicators><title>Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation</title><genre><json:string>Serial 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Canada</affiliation></author><author><persName><forename type="first">Yulia</forename><surname>Worbe</surname><roleName type="degree">MD</roleName></persName><affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</affiliation></author><author><persName><forename type="first">Nehman</forename><surname>Abouazar</surname><roleName type="degree">MD</roleName></persName><affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</affiliation></author><author><persName><forename type="first">Virginie</forename><surname>Czernecki</surname><roleName type="degree">MA</roleName></persName><affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</affiliation></author><author><persName><forename type="first">Hassan</forename><surname>Hosseini</surname><roleName type="degree">MD</roleName></persName><affiliation>Service de Neurologie, Hôpital Henri Mondor, Créteil, France</affiliation></author><author><persName><forename type="first">Antoine</forename><surname>Pelissolo</surname><roleName type="degree">MD</roleName></persName><affiliation>Psychiatrie UMR7593, Pitié‐ Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">Elena</forename><surname>Moro</surname><roleName type="degree">MD</roleName></persName><affiliation>Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Eugénie</forename><surname>Lhommée</surname><roleName type="degree">MA</roleName></persName><affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</affiliation></author><author><persName><forename type="first">Anthony E.</forename><surname>Lang</surname><roleName type="degree">MD</roleName></persName><affiliation>Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Yves</forename><surname>Agid</surname><roleName type="degree">MD</roleName></persName><affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</affiliation></author><author><persName><forename type="first">Alim‐Louis</forename><surname>Benabid</surname><roleName type="degree">MD</roleName></persName><affiliation>Service de Neurochirurgie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</affiliation></author><author><persName><forename type="first">Pierre</forename><surname>Pollak</surname><roleName type="degree">MD</roleName></persName><affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</affiliation></author><author><persName><forename type="first">Luc</forename><surname>Mallet</surname><roleName type="degree">MD</roleName></persName><affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</affiliation><affiliation>Psychiatrie UMR7593, Pitié‐ Salpêtrière, Paris, France</affiliation></author><author><persName><forename type="first">Paul</forename><surname>Krack</surname><roleName type="degree">MD</roleName></persName><note type="correspondence"><p>Correspondence: Département de Neurologie, Centre Hospitalier Universitaire de Grenoble, BP 217, 38043 Grenoble Cedex 9, France</p></note><affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="sub">Official Journal of the Movement Disorder Society</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="pISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><idno type="DOI">10.1002/(ISSN)1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2006-11"></date><biblScope unit="vol">21</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1941">1941</biblScope><biblScope unit="page" to="1946">1946</biblScope></imprint></monogr><idno type="istex">01E1178997AFF59E81BCB9E16F08C203E1942AC9</idno><idno type="DOI">10.1002/mds.21098</idno><idno type="ArticleID">MDS21098</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2006</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Pathological gambling (PG) related to dopaminergic treatment in Parkinson's disease (PD) is part of a spectrum of behavioral disorders called the dopamine dysregulation syndrome (DDS). We describe a series of PD patients with preoperative active PG due to dopaminergic treatment from a total of 598 patients who have undergone surgery for subthalamic nucleus stimulation for disabling motor fluctuations. The patients had systematic open assessment of behavioral symptoms and standardized assessments of motor symptoms, mood, and apathy. Seven patients (6 men, 1 woman; age, 54 ± 9 years; levodopa equivalent dose, 1,390 ± 350 mg/day) had preoperative PG over a mean of 7 years, intolerant to reduction in medication. Six had nonmotor fluctuations and four had other behavioral symptoms consistent with a diagnosis of the DDS. After surgery, motor symptoms improved, allowing for 74% reduction of dopaminergic treatment, below the dosage of gambling onset. In all patients, PG resolved postoperatively after 18 months on average (range, 0–48), although transient worsening occurred in two. Improvement paralleled the time course and degree of reduction in dopaminergic treatment. Nonmotor fluctuations, off period dysphoria, and other symptoms of the DDS improved. Two patients developed persistent apathy. In conclusion, PG and other symptoms of the DDS‐associated dopaminergic treatment improved in our patients following surgery. Dopaminergic dysregulation commonly attributed to pulsatile overstimulation of the limbic dopaminergic system may be subject to desensitization on chronic subthalamic stimulation, which has a relative motor selectivity and allows for decrease in dopaminergic treatment. © 2006 Movement Disorder Society</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Parkinson's disease</term></item><item><term>deep brain stimulation</term></item><item><term>pathological gambling</term></item><item><term>dopamine</term></item><item><term>subthalamic nucleus</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>Article category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2006-01-30">Received</change><change when="2006-05-20">Registration</change><change when="2006-11">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/01E1178997AFF59E81BCB9E16F08C203E1942AC9/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="subtitle">Official Journal of the Movement Disorder Society</title><title type="short">Mov. Disord.</title></titleGroup></publicationMeta><publicationMeta level="part" position="110"><doi origin="wiley" registered="yes">10.1002/mds.v21:11</doi><numberingGroup><numbering type="journalVolume" number="21">21</numbering><numbering type="journalIssue">11</numbering></numberingGroup><coverDate startDate="2006-11">November 2006</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="200" status="forIssue"><doi origin="wiley" registered="yes">10.1002/mds.21098</doi><idGroup><id type="unit" value="MDS21098"></id></idGroup><countGroup><count type="pageTotal" number="6"></count></countGroup><titleGroup><title type="articleCategory">Research Article</title><title type="tocHeading1">Research Articles</title></titleGroup><copyright ownership="thirdParty">Copyright © 2006 Movement Disorder Society</copyright><eventGroup><event type="manuscriptReceived" date="2006-01-30"></event><event type="manuscriptRevised" date="2006-05-16"></event><event type="manuscriptAccepted" date="2006-05-20"></event><event type="publishedOnlineEarlyUnpaginated" date="2006-09-13"></event><event type="firstOnline" date="2006-09-13"></event><event type="publishedOnlineFinalForm" date="2006-11-08"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:2.3.2 mode:FullText source:FullText result:FullText" date="2010-03-09"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-02"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-31"></event></eventGroup><numberingGroup><numbering type="pageFirst">1941</numbering><numbering type="pageLast">1946</numbering></numberingGroup><correspondenceTo>Département de Neurologie, Centre Hospitalier Universitaire de Grenoble, BP 217, 38043 Grenoble Cedex 9, France</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:MDS.MDS21098.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="1"></count><count type="tableTotal" number="2"></count><count type="referenceTotal" number="44"></count><count type="wordTotal" number="4773"></count></countGroup><titleGroup><title type="main" xml:lang="en">Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation</title><title type="short" xml:lang="en">Pathological Gambling</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Claire</givenNames><familyName>Ardouin</familyName><degrees>MA</degrees></personName></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Valerie</givenNames><familyName>Voon</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au3" creatorRole="author" 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disease</keyword><keyword xml:id="kwd2">deep brain stimulation</keyword><keyword xml:id="kwd3">pathological gambling</keyword><keyword xml:id="kwd4">dopamine</keyword><keyword xml:id="kwd5">subthalamic nucleus</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>Pathological gambling (PG) related to dopaminergic treatment in Parkinson's disease (PD) is part of a spectrum of behavioral disorders called the dopamine dysregulation syndrome (DDS). We describe a series of PD patients with preoperative active PG due to dopaminergic treatment from a total of 598 patients who have undergone surgery for subthalamic nucleus stimulation for disabling motor fluctuations. The patients had systematic open assessment of behavioral symptoms and standardized assessments of motor symptoms, mood, and apathy. Seven patients (6 men, 1 woman; age, 54 ± 9 years; levodopa equivalent dose, 1,390 ± 350 mg/day) had preoperative PG over a mean of 7 years, intolerant to reduction in medication. Six had nonmotor fluctuations and four had other behavioral symptoms consistent with a diagnosis of the DDS. After surgery, motor symptoms improved, allowing for 74% reduction of dopaminergic treatment, below the dosage of gambling onset. In all patients, PG resolved postoperatively after 18 months on average (range, 0–48), although transient worsening occurred in two. Improvement paralleled the time course and degree of reduction in dopaminergic treatment. Nonmotor fluctuations, <i>off</i> period dysphoria, and other symptoms of the DDS improved. Two patients developed persistent apathy. In conclusion, PG and other symptoms of the DDS‐associated dopaminergic treatment improved in our patients following surgery. Dopaminergic dysregulation commonly attributed to pulsatile overstimulation of the limbic dopaminergic system may be subject to desensitization on chronic subthalamic stimulation, which has a relative motor selectivity and allows for decrease in dopaminergic treatment. © 2006 Movement Disorder Society</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><!--Version 0.6 générée le 4-12-2015--><mods version="3.6"><titleInfo lang="en"><title>Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Pathological Gambling</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation</title></titleInfo><name type="personal"><namePart type="given">Claire</namePart><namePart type="family">Ardouin</namePart><namePart 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type="termsOfAddress">MD</namePart><affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Virginie</namePart><namePart type="family">Czernecki</namePart><namePart type="termsOfAddress">MA</namePart><affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Hassan</namePart><namePart type="family">Hosseini</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Service de Neurologie, Hôpital Henri Mondor, Créteil, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Antoine</namePart><namePart type="family">Pelissolo</namePart><namePart 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Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Luc</namePart><namePart type="family">Mallet</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</affiliation><affiliation>Psychiatrie UMR7593, Pitié‐ Salpêtrière, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Paul</namePart><namePart type="family">Krack</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</affiliation><description>Correspondence: Département de Neurologie, Centre Hospitalier Universitaire de Grenoble, BP 217, 38043 Grenoble Cedex 9, France</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre authority="originalCategForm">article</genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2006-11</dateIssued><dateCaptured encoding="w3cdtf">2006-01-30</dateCaptured><dateValid encoding="w3cdtf">2006-05-20</dateValid><copyrightDate encoding="w3cdtf">2006</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">1</extent><extent unit="tables">2</extent><extent unit="references">44</extent><extent unit="words">4773</extent></physicalDescription><abstract lang="en">Pathological gambling (PG) related to dopaminergic treatment in Parkinson's disease (PD) is part of a spectrum of behavioral disorders called the dopamine dysregulation syndrome (DDS). We describe a series of PD patients with preoperative active PG due to dopaminergic treatment from a total of 598 patients who have undergone surgery for subthalamic nucleus stimulation for disabling motor fluctuations. The patients had systematic open assessment of behavioral symptoms and standardized assessments of motor symptoms, mood, and apathy. Seven patients (6 men, 1 woman; age, 54 ± 9 years; levodopa equivalent dose, 1,390 ± 350 mg/day) had preoperative PG over a mean of 7 years, intolerant to reduction in medication. Six had nonmotor fluctuations and four had other behavioral symptoms consistent with a diagnosis of the DDS. After surgery, motor symptoms improved, allowing for 74% reduction of dopaminergic treatment, below the dosage of gambling onset. In all patients, PG resolved postoperatively after 18 months on average (range, 0–48), although transient worsening occurred in two. Improvement paralleled the time course and degree of reduction in dopaminergic treatment. Nonmotor fluctuations, off period dysphoria, and other symptoms of the DDS improved. Two patients developed persistent apathy. In conclusion, PG and other symptoms of the DDS‐associated dopaminergic treatment improved in our patients following surgery. Dopaminergic dysregulation commonly attributed to pulsatile overstimulation of the limbic dopaminergic system may be subject to desensitization on chronic subthalamic stimulation, which has a relative motor selectivity and allows for decrease in dopaminergic treatment. © 2006 Movement Disorder Society</abstract><subject lang="en"><genre>Keywords</genre><topic>Parkinson's disease</topic><topic>deep brain stimulation</topic><topic>pathological gambling</topic><topic>dopamine</topic><topic>subthalamic nucleus</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title><subTitle>Official Journal of the Movement Disorder Society</subTitle></titleInfo><titleInfo type="abbreviated"><title>Mov. 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