Anna Castrioto1, Aurélie Funkiewiez2, Bettina Debû3, Roshan Cools4, Eugénie Lhommée3, Claire Ardouin3, Valérie Fraix3, Stephan Chabardès5, Trevor W Robbins6, Pierre Pollak7, Paul Krack3. 1. Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy. 2. Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM-UPMC UMRS 975, IMMA, Fédération de Neurologie, AP-HP Hôpital de la Pitié-Salpêtrière, Paris, France. 3. Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France. 4. Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging Nijmegen, Nijmegen, The Netherlands Department of Psychology, Behavioural, and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK. 5. INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France Neurosurgery Department, CHU de Grenoble, Joseph Fourier University, Grenoble, France. 6. Department of Psychology, Behavioural, and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK. 7. Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France Service de Neurologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Abstract
BACKGROUND: Impulse control disorders (ICD), including pathological gambling, are common in Parkinson's disease (PD) and tend to improve after subthalamic (STN) stimulation after a marked reduction of dopaminergic medication. In order to investigate the effect of STN stimulation on impulsive decision making, we used the Iowa Gambling task (IGT). METHODS: We investigated IGT performance in 20 patients with PD before STN surgery with and without dopaminergic treatment and in 24 age-matched controls. All patients underwent an extensive neuropsychological interview screening for behavioural disorders. Assessment in patients was repeated 3 months after surgery without dopaminergic treatment with and without stimulation. RESULTS: Chronic antiparkinsonian treatment was drastically reduced after surgery (-74%). At baseline, on high chronic dopaminergic treatment 8/20 patients with PD presented with pathological hyperdopaminergic behaviours, which had resolved in 7/8 patients 3 months after surgery on low chronic dopaminergic treatment. Preoperative performance on the IGT was significantly impaired compared to after surgery. CONCLUSIONS: Dopaminergic medication likely contributes to the impairment in decision making underlying ICDs. Deep brain stimulation allows drastic reduction of dopaminergic medication and, thus, concomitant remediation of medication-induced impairment in decision making. 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.
BACKGROUND: Impulse control disorders (ICD), including pathological gambling, are common in Parkinson's disease (PD) and tend to improve after subthalamic (STN) stimulation after a marked reduction of dopaminergic medication. In order to investigate the effect of STN stimulation on impulsive decision making, we used the Iowa Gambling task (IGT). METHODS: We investigated IGT performance in 20 patients with PD before STN surgery with and without dopaminergic treatment and in 24 age-matched controls. All patients underwent an extensive neuropsychological interview screening for behavioural disorders. Assessment in patients was repeated 3 months after surgery without dopaminergic treatment with and without stimulation. RESULTS: Chronic antiparkinsonian treatment was drastically reduced after surgery (-74%). At baseline, on high chronic dopaminergic treatment 8/20 patients with PD presented with pathological hyperdopaminergic behaviours, which had resolved in 7/8 patients 3 months after surgery on low chronic dopaminergic treatment. Preoperative performance on the IGT was significantly impaired compared to after surgery. CONCLUSIONS: Dopaminergic medication likely contributes to the impairment in decision making underlying ICDs. Deep brain stimulation allows drastic reduction of dopaminergic medication and, thus, concomitant remediation of medication-induced impairment in decision making. 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.
Authors: Jason Brandt; Mark Rogerson; Haya Al-Joudi; Gila Reckess; Barnett Shpritz; Chizoba C Umeh; Noha Aljehani; Kelly Mills; Zoltan Mari Journal: Neuropsychology Date: 2014-12-08 Impact factor: 3.295
Authors: Aristide Merola; Alberto Romagnolo; Laura Rizzi; Mario Giorgio Rizzone; Maurizio Zibetti; Michele Lanotte; George Mandybur; Andrew P Duker; Alberto J Espay; Leonardo Lopiano Journal: J Neurol Date: 2016-10-19 Impact factor: 4.849