Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation
Identifieur interne : 001972 ( PascalFrancis/Checkpoint ); précédent : 001971; suivant : 001973Pathological 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 Lhommee [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.
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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.
Affiliations:
- Canada, France
- Auvergne-Rhône-Alpes, Ontario, Rhône-Alpes, Île-de-France
- Créteil, Grenoble, Paris, Toronto
- Centre hospitalier universitaire Grenoble Alpes, Hôpital de la Salpêtrière, Université Joseph Fourier, Université Pierre-et-Marie-Curie, Université de Toronto
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type="city">Créteil</settlement></placeName></affiliation></author><author><name sortKey="Pelissolo, Antoine" sort="Pelissolo, Antoine" uniqKey="Pelissolo A" first="Antoine" last="Pelissolo">Antoine Pelissolo</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Psychiatrie UMR7593, Pitié-Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>7 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Toronto Western Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Lhommee, Eugenie" sort="Lhommee, Eugenie" uniqKey="Lhommee E" first="Eugénie" last="Lhommee">Eugénie Lhommee</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Grenoble</settlement></placeName><orgName type="university">Université Joseph Fourier</orgName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName></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="4"><inist:fA14 i1="02"><s1>Toronto Western Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Agid, Yves" sort="Agid, Yves" uniqKey="Agid Y" first="Yves" last="Agid">Yves Agid</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié-Salpêtrière, Université Pierre et Marie Curie</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName><orgName type="university">Université Pierre-et-Marie-Curie</orgName><placeName><settlement type="city">Paris</settlement><region type="region" nuts="2">Île-de-France</region></placeName><placeName><settlement type="city">Paris</settlement><region type="region" nuts="2">Île-de-France</region></placeName><orgName type="hospital" n="4">Hôpital de la Salpêtrière</orgName></affiliation></author><author><name sortKey="Benabid, Alim Louis" sort="Benabid, Alim Louis" uniqKey="Benabid A" first="Alim-Louis" last="Benabid">Alim-Louis Benabid</name><affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Service de Neurochirurgie, CHU Grenoble, INSERM U318, Université Joseph Fourier</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>12 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Grenoble</settlement></placeName><orgName type="university">Université Joseph Fourier</orgName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><orgName type="hospital" n="4">Centre hospitalier universitaire Grenoble Alpes</orgName></affiliation></author><author><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Grenoble</settlement></placeName><orgName type="university">Université Joseph Fourier</orgName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><orgName type="hospital" n="4">Centre hospitalier universitaire Grenoble Alpes</orgName></affiliation></author><author><name sortKey="Mallet, Luc" sort="Mallet, Luc" uniqKey="Mallet L" first="Luc" last="Mallet">Luc Mallet</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié-Salpêtrière, Université Pierre et Marie Curie</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName><orgName type="university">Université Pierre-et-Marie-Curie</orgName><placeName><settlement type="city">Paris</settlement><region type="region" nuts="2">Île-de-France</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Psychiatrie UMR7593, Pitié-Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>7 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Krack, Paul" sort="Krack, Paul" uniqKey="Krack P" first="Paul" last="Krack">Paul Krack</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Grenoble</settlement></placeName><orgName type="university">Université Joseph Fourier</orgName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">07-0021722</idno><date when="2006">2006</date><idno type="stanalyst">PASCAL 07-0021722 INIST</idno><idno type="RBID">Pascal:07-0021722</idno><idno type="wicri:Area/PascalFrancis/Corpus">001909</idno><idno type="wicri:Area/PascalFrancis/Curation">001412</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">001972</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">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 wicri:level="4"><inist:fA14 i1="01"><s1>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Grenoble</settlement></placeName><orgName type="university">Université Joseph Fourier</orgName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName></affiliation></author><author><name sortKey="Voon, Valerie" sort="Voon, Valerie" uniqKey="Voon V" first="Valerie" last="Voon">Valerie Voon</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Toronto Western Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Worbe, Yulia" sort="Worbe, Yulia" uniqKey="Worbe Y" first="Yulia" last="Worbe">Yulia Worbe</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié-Salpêtrière, Université Pierre et Marie Curie</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName><orgName type="university">Université Pierre-et-Marie-Curie</orgName><placeName><settlement type="city">Paris</settlement><region type="region" nuts="2">Île-de-France</region></placeName></affiliation></author><author><name sortKey="Abouazar, Nehman" sort="Abouazar, Nehman" uniqKey="Abouazar N" first="Nehman" last="Abouazar">Nehman Abouazar</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Grenoble</settlement></placeName><orgName type="university">Université Joseph Fourier</orgName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName></affiliation></author><author><name sortKey="Czernecki, Virginie" sort="Czernecki, Virginie" uniqKey="Czernecki V" first="Virginie" last="Czernecki">Virginie Czernecki</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié-Salpêtrière, Université Pierre et Marie Curie</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName><orgName type="university">Université Pierre-et-Marie-Curie</orgName><placeName><settlement type="city">Paris</settlement><region type="region" nuts="2">Île-de-France</region></placeName></affiliation></author><author><name sortKey="Hosseini, Hassan" sort="Hosseini, Hassan" uniqKey="Hosseini H" first="Hassan" last="Hosseini">Hassan Hosseini</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Service de Neurologie, Hôpital Henri Mondor</s1><s2>Créteil</s2><s3>FRA</s3><sZ>6 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Créteil</settlement></placeName></affiliation></author><author><name sortKey="Pelissolo, Antoine" sort="Pelissolo, Antoine" uniqKey="Pelissolo A" first="Antoine" last="Pelissolo">Antoine Pelissolo</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Psychiatrie UMR7593, Pitié-Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>7 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Toronto Western Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Lhommee, Eugenie" sort="Lhommee, Eugenie" uniqKey="Lhommee E" first="Eugénie" last="Lhommee">Eugénie Lhommee</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Grenoble</settlement></placeName><orgName type="university">Université Joseph Fourier</orgName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName></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="4"><inist:fA14 i1="02"><s1>Toronto Western Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Agid, Yves" sort="Agid, Yves" uniqKey="Agid Y" first="Yves" last="Agid">Yves Agid</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié-Salpêtrière, Université Pierre et Marie Curie</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName><orgName type="university">Université Pierre-et-Marie-Curie</orgName><placeName><settlement type="city">Paris</settlement><region type="region" nuts="2">Île-de-France</region></placeName><placeName><settlement type="city">Paris</settlement><region type="region" nuts="2">Île-de-France</region></placeName><orgName type="hospital" n="4">Hôpital de la Salpêtrière</orgName></affiliation></author><author><name sortKey="Benabid, Alim Louis" sort="Benabid, Alim Louis" uniqKey="Benabid A" first="Alim-Louis" last="Benabid">Alim-Louis Benabid</name><affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Service de Neurochirurgie, CHU Grenoble, INSERM U318, Université Joseph Fourier</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>12 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Grenoble</settlement></placeName><orgName type="university">Université Joseph Fourier</orgName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><orgName type="hospital" n="4">Centre hospitalier universitaire Grenoble Alpes</orgName></affiliation></author><author><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Grenoble</settlement></placeName><orgName type="university">Université Joseph Fourier</orgName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><orgName type="hospital" n="4">Centre hospitalier universitaire Grenoble Alpes</orgName></affiliation></author><author><name sortKey="Mallet, Luc" sort="Mallet, Luc" uniqKey="Mallet L" first="Luc" last="Mallet">Luc Mallet</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié-Salpêtrière, Université Pierre et Marie Curie</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName><orgName type="university">Université Pierre-et-Marie-Curie</orgName><placeName><settlement type="city">Paris</settlement><region type="region" nuts="2">Île-de-France</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Psychiatrie UMR7593, Pitié-Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>7 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Krack, Paul" sort="Krack, Paul" uniqKey="Krack P" first="Paul" last="Krack">Paul Krack</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Grenoble</settlement></placeName><orgName type="university">Université Joseph Fourier</orgName><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Chronic</term><term>Deep brain stimulation</term><term>Dopamine</term><term>Nervous system diseases</term><term>Parkinson disease</term><term>Pathological gambling</term><term>Subthalamic nucleus</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Système nerveux pathologie</term><term>Jeu pathologique</term><term>Parkinson maladie</term><term>Chronique</term><term>Noyau sousthalamique</term><term>Dopamine</term><term>Stimulation cérébrale profonde</term></keywords></textClass></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.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0885-3185</s0></fA01><fA03 i2="1"><s0>Mov. disord.</s0></fA03><fA05><s2>21</s2></fA05><fA06><s2>11</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation</s1></fA08><fA11 i1="01" i2="1"><s1>ARDOUIN (Claire)</s1></fA11><fA11 i1="02" i2="1"><s1>VOON (Valerie)</s1></fA11><fA11 i1="03" i2="1"><s1>WORBE (Yulia)</s1></fA11><fA11 i1="04" i2="1"><s1>ABOUAZAR (Nehman)</s1></fA11><fA11 i1="05" i2="1"><s1>CZERNECKI (Virginie)</s1></fA11><fA11 i1="06" i2="1"><s1>HOSSEINI (Hassan)</s1></fA11><fA11 i1="07" i2="1"><s1>PELISSOLO (Antoine)</s1></fA11><fA11 i1="08" i2="1"><s1>MORO (Elena)</s1></fA11><fA11 i1="09" i2="1"><s1>LHOMMEE (Eugénie)</s1></fA11><fA11 i1="10" i2="1"><s1>LANG (Anthony E.)</s1></fA11><fA11 i1="11" i2="1"><s1>AGID (Yves)</s1></fA11><fA11 i1="12" i2="1"><s1>BENABID (Alim-Louis)</s1></fA11><fA11 i1="13" i2="1"><s1>POLLAK (Pierre)</s1></fA11><fA11 i1="14" i2="1"><s1>MALLET (Luc)</s1></fA11><fA11 i1="15" i2="1"><s1>KRACK (Paul)</s1></fA11><fA14 i1="01"><s1>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ><sZ>15 aut.</sZ></fA14><fA14 i1="02"><s1>Toronto Western Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></fA14><fA14 i1="03"><s1>Centre d'Investigation Clinique 9503, INSERM U679, CHU Pitié-Salpêtrière, Université Pierre et Marie Curie</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></fA14><fA14 i1="04"><s1>Service de Neurologie, Hôpital Henri Mondor</s1><s2>Créteil</s2><s3>FRA</s3><sZ>6 aut.</sZ></fA14><fA14 i1="05"><s1>Psychiatrie UMR7593, Pitié-Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>7 aut.</sZ><sZ>14 aut.</sZ></fA14><fA14 i1="06"><s1>Service de Neurochirurgie, CHU Grenoble, INSERM U318, Université Joseph Fourier</s1><s2>Grenoble</s2><s3>FRA</s3><sZ>12 aut.</sZ></fA14><fA20><s1>1941-1946</s1></fA20><fA21><s1>2006</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>20953</s2><s5>354000158935070190</s5></fA43><fA44><s0>0000</s0><s1>© 2007 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>44 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>07-0021722</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Movement disorders</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>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.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17</s0></fC02><fC02 i1="02" i2="X"><s0>002B17G</s0></fC02><fC02 i1="03" i2="X"><s0>002B17A03</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Système nerveux pathologie</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Jeu pathologique</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Pathological gambling</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Juego patológico</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Parkinson maladie</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Parkinson 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l="FRE"><s0>Trouble contrôle impulsion</s0><s2>NM</s2><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Impulse control disorder</s0><s2>NM</s2><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Trastorno control impulso</s0><s2>NM</s2><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Encéphale pathologie</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Extrapyramidal syndrome</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Système nerveux central pathologie</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Système nerveux central</s0><s5>42</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Central nervous system</s0><s5>42</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Sistema nervioso central</s0><s5>42</s5></fC07><fC07 i1="07" i2="X" l="FRE"><s0>Catécholamine</s0><s5>43</s5></fC07><fC07 i1="07" i2="X" l="ENG"><s0>Catecholamine</s0><s5>43</s5></fC07><fC07 i1="07" i2="X" l="SPA"><s0>Catecolamina</s0><s5>43</s5></fC07><fC07 i1="08" i2="X" l="FRE"><s0>Neurotransmetteur</s0><s5>44</s5></fC07><fC07 i1="08" i2="X" l="ENG"><s0>Neurotransmitter</s0><s5>44</s5></fC07><fC07 i1="08" i2="X" l="SPA"><s0>Neurotransmisor</s0><s5>44</s5></fC07><fN21><s1>010</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist><affiliations><list><country><li>Canada</li><li>France</li></country><region><li>Auvergne-Rhône-Alpes</li><li>Ontario</li><li>Rhône-Alpes</li><li>Île-de-France</li></region><settlement><li>Créteil</li><li>Grenoble</li><li>Paris</li><li>Toronto</li></settlement><orgName><li>Centre hospitalier universitaire Grenoble Alpes</li><li>Hôpital de la Salpêtrière</li><li>Université Joseph Fourier</li><li>Université Pierre-et-Marie-Curie</li><li>Université de Toronto</li></orgName></list><tree><country name="France"><noRegion><name sortKey="Ardouin, Claire" sort="Ardouin, Claire" uniqKey="Ardouin C" first="Claire" last="Ardouin">Claire Ardouin</name></noRegion><name sortKey="Abouazar, Nehman" sort="Abouazar, Nehman" uniqKey="Abouazar N" first="Nehman" last="Abouazar">Nehman Abouazar</name><name sortKey="Agid, Yves" sort="Agid, Yves" uniqKey="Agid Y" first="Yves" last="Agid">Yves Agid</name><name sortKey="Benabid, Alim Louis" sort="Benabid, Alim Louis" uniqKey="Benabid A" first="Alim-Louis" last="Benabid">Alim-Louis Benabid</name><name sortKey="Czernecki, Virginie" sort="Czernecki, Virginie" uniqKey="Czernecki V" first="Virginie" last="Czernecki">Virginie Czernecki</name><name sortKey="Hosseini, Hassan" sort="Hosseini, Hassan" uniqKey="Hosseini H" first="Hassan" last="Hosseini">Hassan Hosseini</name><name sortKey="Krack, Paul" sort="Krack, Paul" uniqKey="Krack P" first="Paul" last="Krack">Paul Krack</name><name sortKey="Lhommee, Eugenie" sort="Lhommee, Eugenie" uniqKey="Lhommee E" first="Eugénie" last="Lhommee">Eugénie Lhommee</name><name sortKey="Mallet, Luc" sort="Mallet, Luc" uniqKey="Mallet L" first="Luc" last="Mallet">Luc Mallet</name><name sortKey="Mallet, Luc" sort="Mallet, Luc" uniqKey="Mallet L" first="Luc" last="Mallet">Luc Mallet</name><name sortKey="Pelissolo, Antoine" sort="Pelissolo, Antoine" uniqKey="Pelissolo A" first="Antoine" last="Pelissolo">Antoine Pelissolo</name><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name><name sortKey="Worbe, Yulia" sort="Worbe, Yulia" uniqKey="Worbe Y" first="Yulia" last="Worbe">Yulia Worbe</name></country><country name="Canada"><region name="Ontario"><name sortKey="Voon, Valerie" sort="Voon, Valerie" uniqKey="Voon V" first="Valerie" last="Voon">Valerie Voon</name></region><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. 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|texte= Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation
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