Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation
Identifieur interne : 000138 ( France/Analysis ); précédent : 000137; suivant : 000139Pathological 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.
English descriptors
- KwdEn :
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
Url:
DOI: 10.1002/mds.21098
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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ISTEX:01E1178997AFF59E81BCB9E16F08C203E1942AC9Le document en format XML
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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"><country xml:lang="fr">Canada</country><wicri:regionArea>Toronto Western Hospital, University of Toronto, Toronto, Ontario</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Worbe, Yulia" sort="Worbe, Yulia" uniqKey="Worbe Y" first="Yulia" last="Worbe">Yulia Worbe</name><affiliation wicri:level="4"><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><placeName><settlement type="city">Paris</settlement></placeName><orgName type="university">Université 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xml:lang="fr">France</country><wicri:regionArea>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble</wicri:regionArea><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"><country xml:lang="fr">Canada</country><wicri:regionArea>Toronto Western Hospital, University of Toronto, Toronto, Ontario</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Agid, Yves" sort="Agid, Yves" uniqKey="Agid Y" first="Yves" last="Agid">Yves Agid</name><affiliation wicri:level="4"><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><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 Ouis" sort="Benabid, Alim Ouis" uniqKey="Benabid A" first="Alim-Louis" last="Benabid">Alim-Louis Benabid</name><affiliation wicri:level="4"><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurochirurgie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble</wicri:regionArea><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"><country xml:lang="fr">France</country><wicri:regionArea>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble</wicri:regionArea><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"><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><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"><country xml:lang="fr">France</country><wicri:regionArea>Psychiatrie UMR7593, Pitié‐ Salpêtrière, Paris</wicri:regionArea><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"><country xml:lang="fr">France</country><wicri:regionArea>Département de Neurologie, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble</wicri:regionArea><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><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="volume">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><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 Ouis" sort="Benabid, Alim Ouis" 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="Lhommée">Eugénie Lhommée</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. Lang</name><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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