Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson's disease
Identifieur interne : 002043 ( Main/Corpus ); précédent : 002042; suivant : 002044Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson's disease
Auteurs : Alexandre Eusebio ; Tatiana Witjas ; Julien Cohen ; Frédérique Fluchère ; Elisabeth Jouve ; Jean Régis ; Jean-Philippe AzulaySource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2013-08.
Abstract
Background Behavioural disorders associated with compulsive use of dopaminergic drugs for Parkinson's disease (PD) such as dopamine dysregulation syndrome (DDS) and impulse control disorders (ICDs) may have devastating consequences and are challenging to manage. Whether or not such patients should undergo subthalamic nucleus (STN) deep brain stimulation (DBS) is controversial. A few case reports and small series have reported contrasting effects of STN DBS on dopamine misuse and ICDs, while a recent prospective study found clear beneficial effects of STN DBS on these disorders. Methods We conducted an observational study on 110 consecutive parkinsonian patients scheduled for STN DBS surgery. Patients were assessed preoperatively through extensive behavioural and psychiatric evaluations and divided into two groups: with or without compulsive dopaminergic medication use. Evaluations were repeated 1 year after surgery in both groups. Results Before surgery 18 patients (16.3%) were compulsive dopamine users of whom 12 (10.9%) fulfilled all criteria for DDS. 90% of these patients also had at least one ICD compared to 20% in the group without compulsive dopamine use. One year after surgery, one patient had persistent compulsive dopamine use, while no new occurrences were reported in the group without the condition before surgery. STN DBS did not provoke any major psychiatric complications and ICDs were reduced in all patients. Conclusions Our results suggest that STN DBS may reduce compulsive use of dopaminergic medication and its behavioural consequences. Whether this improvement is the result of STN DBS or the consequence of better treatment management remains to be established.
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DOI: 10.1136/jnnp-2012-302387
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AMU CNRS, Marseille, France</mods:affiliation></affiliation></author><author><name sortKey="Cohen, Julien" sort="Cohen, Julien" uniqKey="Cohen J" first="Julien" last="Cohen">Julien Cohen</name><affiliation><mods:affiliation>Department of Psychiatry and Addiction, CHU Sainte-Marguerite, APHM, Marseille, France</mods:affiliation></affiliation></author><author><name sortKey="Fluchere, Frederique" sort="Fluchere, Frederique" uniqKey="Fluchere F" first="Frédérique" last="Fluchère">Frédérique Fluchère</name><affiliation><mods:affiliation>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</mods:affiliation></affiliation></author><author><name sortKey="Jouve, Elisabeth" sort="Jouve, Elisabeth" uniqKey="Jouve E" first="Elisabeth" last="Jouve">Elisabeth Jouve</name><affiliation><mods:affiliation>Centre of Clinical Investigations, CHU Timone, APHM, Marseille, France</mods:affiliation></affiliation></author><author><name sortKey="Regis, Jean" sort="Regis, Jean" 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Marseille, France</mods:affiliation></affiliation><affiliation><mods:affiliation>Institut de Neurosciences de La Timone, UMR 7289 AMU CNRS, Marseille, France</mods:affiliation></affiliation></author><author><name sortKey="Cohen, Julien" sort="Cohen, Julien" uniqKey="Cohen J" first="Julien" last="Cohen">Julien Cohen</name><affiliation><mods:affiliation>Department of Psychiatry and Addiction, CHU Sainte-Marguerite, APHM, Marseille, France</mods:affiliation></affiliation></author><author><name sortKey="Fluchere, Frederique" sort="Fluchere, Frederique" uniqKey="Fluchere F" first="Frédérique" last="Fluchère">Frédérique Fluchère</name><affiliation><mods:affiliation>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</mods:affiliation></affiliation></author><author><name sortKey="Jouve, Elisabeth" sort="Jouve, Elisabeth" uniqKey="Jouve E" first="Elisabeth" last="Jouve">Elisabeth Jouve</name><affiliation><mods:affiliation>Centre of Clinical Investigations, CHU Timone, APHM, Marseille, France</mods:affiliation></affiliation></author><author><name sortKey="Regis, Jean" sort="Regis, Jean" uniqKey="Regis J" first="Jean" last="Régis">Jean Régis</name><affiliation><mods:affiliation>Department of Functional and Stereotactic Neurosurgery, CHU Timone, APHM, Marseille, France</mods:affiliation></affiliation></author><author><name sortKey="Azulay, Jean Philippe" sort="Azulay, Jean Philippe" uniqKey="Azulay J" first="Jean-Philippe" last="Azulay">Jean-Philippe Azulay</name><affiliation><mods:affiliation>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</mods:affiliation></affiliation><affiliation><mods:affiliation>Institut de Neurosciences de La Timone, UMR 7289 AMU CNRS, Marseille, France</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2013-08">2013-08</date><biblScope unit="volume">84</biblScope><biblScope unit="issue">8</biblScope><biblScope unit="page" from="868">868</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">52A8F95C5C4D61FB9F74B0B6002D0136DF3D19CC</idno><idno type="DOI">10.1136/jnnp-2012-302387</idno><idno type="href">jnnp-84-868.pdf</idno><idno type="ArticleID">jnnp-2012-302387</idno><idno type="PMID">23447648</idno><idno type="local">jnnp;84/8/868</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background Behavioural disorders associated with compulsive use of dopaminergic drugs for Parkinson's disease (PD) such as dopamine dysregulation syndrome (DDS) and impulse control disorders (ICDs) may have devastating consequences and are challenging to manage. Whether or not such patients should undergo subthalamic nucleus (STN) deep brain stimulation (DBS) is controversial. A few case reports and small series have reported contrasting effects of STN DBS on dopamine misuse and ICDs, while a recent prospective study found clear beneficial effects of STN DBS on these disorders. Methods We conducted an observational study on 110 consecutive parkinsonian patients scheduled for STN DBS surgery. Patients were assessed preoperatively through extensive behavioural and psychiatric evaluations and divided into two groups: with or without compulsive dopaminergic medication use. Evaluations were repeated 1 year after surgery in both groups. Results Before surgery 18 patients (16.3%) were compulsive dopamine users of whom 12 (10.9%) fulfilled all criteria for DDS. 90% of these patients also had at least one ICD compared to 20% in the group without compulsive dopamine use. One year after surgery, one patient had persistent compulsive dopamine use, while no new occurrences were reported in the group without the condition before surgery. STN DBS did not provoke any major psychiatric complications and ICDs were reduced in all patients. Conclusions Our results suggest that STN DBS may reduce compulsive use of dopaminergic medication and its behavioural consequences. Whether this improvement is the result of STN DBS or the consequence of better treatment management remains to be established.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Alexandre Eusebio</name><affiliations><json:string>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</json:string><json:string>Institut de Neurosciences de La Timone, UMR 7289 AMU CNRS, Marseille, France</json:string></affiliations></json:item><json:item><name>Tatiana Witjas</name><affiliations><json:string>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</json:string><json:string>Institut de Neurosciences de La Timone, UMR 7289 AMU CNRS, Marseille, France</json:string></affiliations></json:item><json:item><name>Julien Cohen</name><affiliations><json:string>Department of Psychiatry and Addiction, CHU Sainte-Marguerite, APHM, Marseille, France</json:string></affiliations></json:item><json:item><name>Frédérique Fluchère</name><affiliations><json:string>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</json:string></affiliations></json:item><json:item><name>Elisabeth Jouve</name><affiliations><json:string>Centre of Clinical Investigations, CHU Timone, APHM, Marseille, France</json:string></affiliations></json:item><json:item><name>Jean Régis</name><affiliations><json:string>Department of Functional and Stereotactic Neurosurgery, CHU Timone, APHM, Marseille, France</json:string></affiliations></json:item><json:item><name>Jean-Philippe Azulay</name><affiliations><json:string>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</json:string><json:string>Institut de Neurosciences de La Timone, UMR 7289 AMU CNRS, Marseille, France</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Movement disorders</value></json:item><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>STEREOTAXIC SURGERY</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>MOVEMENT DISORDERS</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>BEHAVIOURAL DISORDER</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Background Behavioural disorders associated with compulsive use of dopaminergic drugs for Parkinson's disease (PD) such as dopamine dysregulation syndrome (DDS) and impulse control disorders (ICDs) may have devastating consequences and are challenging to manage. Whether or not such patients should undergo subthalamic nucleus (STN) deep brain stimulation (DBS) is controversial. A few case reports and small series have reported contrasting effects of STN DBS on dopamine misuse and ICDs, while a recent prospective study found clear beneficial effects of STN DBS on these disorders. Methods We conducted an observational study on 110 consecutive parkinsonian patients scheduled for STN DBS surgery. Patients were assessed preoperatively through extensive behavioural and psychiatric evaluations and divided into two groups: with or without compulsive dopaminergic medication use. Evaluations were repeated 1 year after surgery in both groups. Results Before surgery 18 patients (16.3%) were compulsive dopamine users of whom 12 (10.9%) fulfilled all criteria for DDS. 90% of these patients also had at least one ICD compared to 20% in the group without compulsive dopamine use. One year after surgery, one patient had persistent compulsive dopamine use, while no new occurrences were reported in the group without the condition before surgery. STN DBS did not provoke any major psychiatric complications and ICDs were reduced in all patients. Conclusions Our results suggest that STN DBS may reduce compulsive use of dopaminergic medication and its behavioural consequences. Whether this improvement is the result of STN DBS or the consequence of better treatment management remains to be established.</abstract><qualityIndicators><score>7.988</score><pdfVersion>1.3</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1703</abstractCharCount><pdfWordCount>5289</pdfWordCount><pdfCharCount>35745</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>249</abstractWordCount></qualityIndicators><title>Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson's disease</title><pmid><json:string>23447648</json:string></pmid><genre><json:string>research-article</json:string></genre><host><volume>84</volume><pages><first>868</first></pages><issn><json:string>0022-3050</json:string></issn><issue>8</issue><genre></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-330X</json:string></eissn><title>Journal 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Publishing Group Ltd</publisher><availability><p>BMJ</p></availability><date>2013-02-27</date></publicationStmt><notesStmt><note>AE and TW contributed equally.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson's disease</title><author><persName><forename type="first">Alexandre</forename><surname>Eusebio</surname></persName><affiliation>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</affiliation><affiliation>Institut de Neurosciences de La Timone, UMR 7289 AMU CNRS, Marseille, France</affiliation></author><author><persName><forename type="first">Tatiana</forename><surname>Witjas</surname></persName><affiliation>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</affiliation><affiliation>Institut de Neurosciences de La Timone, UMR 7289 AMU CNRS, Marseille, France</affiliation></author><author><persName><forename type="first">Julien</forename><surname>Cohen</surname></persName><affiliation>Department of Psychiatry and Addiction, CHU Sainte-Marguerite, APHM, Marseille, France</affiliation></author><author><persName><forename type="first">Frédérique</forename><surname>Fluchère</surname></persName><affiliation>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</affiliation></author><author><persName><forename type="first">Elisabeth</forename><surname>Jouve</surname></persName><affiliation>Centre of Clinical Investigations, CHU Timone, APHM, Marseille, France</affiliation></author><author><persName><forename type="first">Jean</forename><surname>Régis</surname></persName><affiliation>Department of Functional and Stereotactic Neurosurgery, CHU Timone, APHM, Marseille, France</affiliation></author><author><persName><forename type="first">Jean-Philippe</forename><surname>Azulay</surname></persName><affiliation>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</affiliation><affiliation>Institut de Neurosciences de La Timone, UMR 7289 AMU CNRS, Marseille, France</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2013-08"></date><biblScope unit="volume">84</biblScope><biblScope unit="issue">8</biblScope><biblScope unit="page" from="868">868</biblScope></imprint></monogr><idno type="istex">52A8F95C5C4D61FB9F74B0B6002D0136DF3D19CC</idno><idno type="DOI">10.1136/jnnp-2012-302387</idno><idno type="href">jnnp-84-868.pdf</idno><idno type="ArticleID">jnnp-2012-302387</idno><idno type="PMID">23447648</idno><idno type="local">jnnp;84/8/868</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2013-02-27</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background Behavioural disorders associated with compulsive use of dopaminergic drugs for Parkinson's disease (PD) such as dopamine dysregulation syndrome (DDS) and impulse control disorders (ICDs) may have devastating consequences and are challenging to manage. Whether or not such patients should undergo subthalamic nucleus (STN) deep brain stimulation (DBS) is controversial. A few case reports and small series have reported contrasting effects of STN DBS on dopamine misuse and ICDs, while a recent prospective study found clear beneficial effects of STN DBS on these disorders. Methods We conducted an observational study on 110 consecutive parkinsonian patients scheduled for STN DBS surgery. Patients were assessed preoperatively through extensive behavioural and psychiatric evaluations and divided into two groups: with or without compulsive dopaminergic medication use. Evaluations were repeated 1 year after surgery in both groups. Results Before surgery 18 patients (16.3%) were compulsive dopamine users of whom 12 (10.9%) fulfilled all criteria for DDS. 90% of these patients also had at least one ICD compared to 20% in the group without compulsive dopamine use. One year after surgery, one patient had persistent compulsive dopamine use, while no new occurrences were reported in the group without the condition before surgery. STN DBS did not provoke any major psychiatric complications and ICDs were reduced in all patients. Conclusions Our results suggest that STN DBS may reduce compulsive use of dopaminergic medication and its behavioural consequences. Whether this improvement is the result of STN DBS or the consequence of better treatment management remains to be established.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>PARKINSON'S DISEASE</term></item><item><term>STEREOTAXIC SURGERY</term></item><item><term>MOVEMENT DISORDERS</term></item><item><term>BEHAVIOURAL DISORDER</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2013-02-27">Created</change><change when="2013-08">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/52A8F95C5C4D61FB9F74B0B6002D0136DF3D19CC/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-id journal-id-type="publisher-id">jnnp</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><abbrev-journal-title>J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">jnnp-2012-302387</article-id><article-id pub-id-type="doi">10.1136/jnnp-2012-302387</article-id><article-id pub-id-type="other">jnnp;84/8/868</article-id><article-id pub-id-type="other">jnnp;jnnp-2012-302387</article-id><article-id pub-id-type="pmid">23447648</article-id><article-id pub-id-type="other">868</article-id><article-id pub-id-type="other">jnnp-2012-302387</article-id><article-categories><subj-group subj-group-type="heading"><subject>Movement disorders</subject></subj-group><series-title>Research paper</series-title></article-categories><title-group><article-title>Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson's disease</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Eusebio</surname><given-names>Alexandre</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Witjas</surname><given-names>Tatiana</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Cohen</surname><given-names>Julien</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Fluchère</surname><given-names>Frédérique</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Jouve</surname><given-names>Elisabeth</given-names></name><xref ref-type="aff" rid="af4">4</xref></contrib><contrib contrib-type="author"><name><surname>Régis</surname><given-names>Jean</given-names></name><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>Azulay</surname><given-names>Jean-Philippe</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af2">2</xref></contrib></contrib-group><aff id="af1"><label>1</label><addr-line>Department of Neurology and Movement Disorders</addr-line>, <institution>CHU Timone, APHM</institution>, <addr-line>Marseille</addr-line>, <country>France</country></aff><aff id="af2"><label>2</label><institution>Institut de Neurosciences de La Timone, UMR 7289 AMU CNRS</institution>, <addr-line>Marseille</addr-line>, <country>France</country></aff><aff id="af3"><label>3</label><addr-line>Department of Psychiatry and Addiction</addr-line>, <institution>CHU Sainte-Marguerite, APHM</institution>, <addr-line>Marseille</addr-line>, <country>France</country></aff><aff id="af4"><label>4</label><institution>Centre of Clinical Investigations, CHU Timone, APHM</institution>, <addr-line>Marseille</addr-line>, <country>France</country></aff><aff id="af5"><label>5</label><addr-line>Department of Functional and Stereotactic Neurosurgery</addr-line>, <institution>CHU Timone, APHM</institution>, <addr-line>Marseille</addr-line>, <country>France</country></aff><author-notes><corresp><label>Correspondence to</label> Dr Alexandre Eusebio, Department of Neurology and Movement Disorders, CHU Timone, APHM, 264 rue Saint-Pierre, 13385 Marseille Cedex 05, France; <email>alexandre.eusebio@ap-hm.fr</email></corresp><fn><p>AE and TW contributed equally.</p></fn></author-notes><pub-date pub-type="ppub"><month>8</month><year>2013</year></pub-date><pub-date pub-type="epub-original"><day>27</day><month>2</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>27</day><month>2</month><year>2013</year></pub-date><volume>84</volume><volume-id pub-id-type="other">84</volume-id><volume-id pub-id-type="other">84</volume-id><issue>8</issue><issue-id pub-id-type="other">jnnp;84/8</issue-id><issue-id pub-id-type="other">8</issue-id><issue-id pub-id-type="other">84/8</issue-id><fpage>868</fpage><history><date date-type="received"><day>28</day><month>1</month><year>2012</year></date><date date-type="rev-recd"><day>25</day><month>1</month><year>2013</year></date><date date-type="accepted"><day>6</day><month>2</month><year>2013</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2013</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-84-868.pdf"></self-uri><abstract><sec><title>Background</title><p>Behavioural disorders associated with compulsive use of dopaminergic drugs for Parkinson's disease (PD) such as dopamine dysregulation syndrome (DDS) and impulse control disorders (ICDs) may have devastating consequences and are challenging to manage. Whether or not such patients should undergo subthalamic nucleus (STN) deep brain stimulation (DBS) is controversial. A few case reports and small series have reported contrasting effects of STN DBS on dopamine misuse and ICDs, while a recent prospective study found clear beneficial effects of STN DBS on these disorders.</p></sec><sec><title>Methods</title><p>We conducted an observational study on 110 consecutive parkinsonian patients scheduled for STN DBS surgery. Patients were assessed preoperatively through extensive behavioural and psychiatric evaluations and divided into two groups: with or without compulsive dopaminergic medication use. Evaluations were repeated 1 year after surgery in both groups.</p></sec><sec><title>Results</title><p>Before surgery 18 patients (16.3%) were compulsive dopamine users of whom 12 (10.9%) fulfilled all criteria for DDS. 90% of these patients also had at least one ICD compared to 20% in the group without compulsive dopamine use. One year after surgery, one patient had persistent compulsive dopamine use, while no new occurrences were reported in the group without the condition before surgery. STN DBS did not provoke any major psychiatric complications and ICDs were reduced in all patients.</p></sec><sec><title>Conclusions</title><p>Our results suggest that STN DBS may reduce compulsive use of dopaminergic medication and its behavioural consequences. Whether this improvement is the result of STN DBS or the consequence of better treatment management remains to be established.</p></sec></abstract><kwd-group><kwd>PARKINSON'S DISEASE</kwd><kwd>STEREOTAXIC SURGERY</kwd><kwd>MOVEMENT DISORDERS</kwd><kwd>BEHAVIOURAL DISORDER</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><partName>Research paper</partName><title>Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson's disease</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><partName>Research paper</partName><title>Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson's disease</title></titleInfo><name type="personal"><namePart type="given">Alexandre</namePart><namePart type="family">Eusebio</namePart><affiliation>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</affiliation><affiliation>Institut de Neurosciences de La Timone, UMR 7289 AMU CNRS, Marseille, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Tatiana</namePart><namePart type="family">Witjas</namePart><affiliation>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</affiliation><affiliation>Institut de Neurosciences de La Timone, UMR 7289 AMU CNRS, Marseille, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Julien</namePart><namePart type="family">Cohen</namePart><affiliation>Department of Psychiatry and Addiction, CHU Sainte-Marguerite, APHM, Marseille, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Frédérique</namePart><namePart type="family">Fluchère</namePart><affiliation>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Elisabeth</namePart><namePart type="family">Jouve</namePart><affiliation>Centre of Clinical Investigations, CHU Timone, APHM, Marseille, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jean</namePart><namePart type="family">Régis</namePart><affiliation>Department of Functional and Stereotactic Neurosurgery, CHU Timone, APHM, Marseille, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jean-Philippe</namePart><namePart type="family">Azulay</namePart><affiliation>Department of Neurology and Movement Disorders, CHU Timone, APHM, Marseille, France</affiliation><affiliation>Institut de Neurosciences de La Timone, UMR 7289 AMU CNRS, Marseille, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2013-08</dateIssued><dateCreated encoding="w3cdtf">2013-02-27</dateCreated><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Background Behavioural disorders associated with compulsive use of dopaminergic drugs for Parkinson's disease (PD) such as dopamine dysregulation syndrome (DDS) and impulse control disorders (ICDs) may have devastating consequences and are challenging to manage. Whether or not such patients should undergo subthalamic nucleus (STN) deep brain stimulation (DBS) is controversial. A few case reports and small series have reported contrasting effects of STN DBS on dopamine misuse and ICDs, while a recent prospective study found clear beneficial effects of STN DBS on these disorders. Methods We conducted an observational study on 110 consecutive parkinsonian patients scheduled for STN DBS surgery. Patients were assessed preoperatively through extensive behavioural and psychiatric evaluations and divided into two groups: with or without compulsive dopaminergic medication use. Evaluations were repeated 1 year after surgery in both groups. Results Before surgery 18 patients (16.3%) were compulsive dopamine users of whom 12 (10.9%) fulfilled all criteria for DDS. 90% of these patients also had at least one ICD compared to 20% in the group without compulsive dopamine use. One year after surgery, one patient had persistent compulsive dopamine use, while no new occurrences were reported in the group without the condition before surgery. STN DBS did not provoke any major psychiatric complications and ICDs were reduced in all patients. Conclusions Our results suggest that STN DBS may reduce compulsive use of dopaminergic medication and its behavioural consequences. Whether this improvement is the result of STN DBS or the consequence of better treatment management remains to be established.</abstract><note type="footnotes">AE and TW contributed equally.</note><subject><genre>Keywords</genre><topic>PARKINSON'S DISEASE</topic><topic>STEREOTAXIC SURGERY</topic><topic>MOVEMENT DISORDERS</topic><topic>BEHAVIOURAL DISORDER</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID">jnnp</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2013</date><detail type="volume"><caption>vol.</caption><number>84</number></detail><detail type="issue"><caption>no.</caption><number>8</number></detail><extent unit="pages"><start>868</start></extent></part></relatedItem><identifier type="istex">52A8F95C5C4D61FB9F74B0B6002D0136DF3D19CC</identifier><identifier type="DOI">10.1136/jnnp-2012-302387</identifier><identifier type="href">jnnp-84-868.pdf</identifier><identifier type="ArticleID">jnnp-2012-302387</identifier><identifier type="PMID">23447648</identifier><identifier type="local">jnnp;84/8/868</identifier><accessCondition type="use and reproduction" contentType="copyright">Published by the BMJ Publishing Group Limited. 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