Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation
Identifieur interne : 000856 ( Istex/Curation ); précédent : 000855; suivant : 000857Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation
Auteurs : Claire Ardouin [France] ; Valerie Voon [Canada] ; Yulia Worbe [France] ; Nehman Abouazar [France] ; Virginie Czernecki [France] ; Hassan Hosseini [France] ; Antoine Pelissolo [France] ; Elena Moro [Canada] ; Eugénie Lhommée [France] ; Anthony E. Lang [Canada] ; Yves Agid [France] ; Alim-Louis Benabid [France] ; Pierre Pollak [France] ; Luc Mallet [France] ; Paul Krack [France]Source :
- 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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France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble</wicri:regionArea></affiliation></author><author><name sortKey="Voon, Valerie" sort="Voon, Valerie" uniqKey="Voon V" first="Valerie" last="Voon">Valerie Voon</name><affiliation wicri:level="1"><mods:affiliation>Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Toronto Western Hospital, University of Toronto, Toronto, Ontario</wicri:regionArea></affiliation></author><author><name sortKey="Worbe, Yulia" sort="Worbe, Yulia" uniqKey="Worbe Y" first="Yulia" last="Worbe">Yulia Worbe</name><affiliation wicri:level="1"><mods:affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Abouazar, Nehman" sort="Abouazar, Nehman" uniqKey="Abouazar N" first="Nehman" last="Abouazar">Nehman Abouazar</name><affiliation wicri:level="1"><mods:affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble</wicri:regionArea></affiliation></author><author><name sortKey="Czernecki, Virginie" sort="Czernecki, Virginie" uniqKey="Czernecki V" first="Virginie" last="Czernecki">Virginie Czernecki</name><affiliation wicri:level="1"><mods:affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Hosseini, Hassan" sort="Hosseini, Hassan" uniqKey="Hosseini H" first="Hassan" last="Hosseini">Hassan Hosseini</name><affiliation wicri:level="1"><mods:affiliation>Service de Neurologie, Hôpital Henri Mondor, Créteil, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurologie, Hôpital Henri Mondor, Créteil</wicri:regionArea></affiliation></author><author><name sortKey="Pelissolo, Antoine" sort="Pelissolo, Antoine" uniqKey="Pelissolo A" first="Antoine" last="Pelissolo">Antoine Pelissolo</name><affiliation wicri:level="1"><mods:affiliation>Psychiatrie UMR7593, Pitié‐ Salpêtrière, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Psychiatrie UMR7593, Pitié‐ Salpêtrière, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation wicri:level="1"><mods:affiliation>Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Toronto Western Hospital, University of Toronto, Toronto, Ontario</wicri:regionArea></affiliation></author><author><name sortKey="Lhommee, Eugenie" sort="Lhommee, Eugenie" uniqKey="Lhommee E" first="Eugénie" last="Lhommée">Eugénie Lhommée</name><affiliation wicri:level="1"><mods:affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble</wicri:regionArea></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 wicri:level="1"><mods:affiliation>Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Toronto Western Hospital, University of Toronto, Toronto, Ontario</wicri:regionArea></affiliation></author><author><name sortKey="Agid, Yves" sort="Agid, Yves" uniqKey="Agid Y" first="Yves" last="Agid">Yves Agid</name><affiliation wicri:level="1"><mods:affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris</wicri:regionArea></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 wicri:level="1"><mods:affiliation>Service de Neurochirurgie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurochirurgie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble</wicri:regionArea></affiliation></author><author><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name><affiliation wicri:level="1"><mods:affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble</wicri:regionArea></affiliation></author><author><name sortKey="Mallet, Luc" sort="Mallet, Luc" uniqKey="Mallet L" first="Luc" last="Mallet">Luc Mallet</name><affiliation wicri:level="1"><mods:affiliation>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié‐Salpêtrière, Université Pierre et Marie Curie, Paris</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Psychiatrie UMR7593, Pitié‐ Salpêtrière, Paris, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Psychiatrie UMR7593, Pitié‐ Salpêtrière, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Krack, Paul" sort="Krack, Paul" uniqKey="Krack P" first="Paul" last="Krack">Paul Krack</name><affiliation wicri:level="1"><mods:affiliation>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble</wicri:regionArea></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></record>Pour manipuler ce document sous Unix (Dilib)
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