Addiction in Parkinson's disease: Impact of subthalamic nucleus deep brain stimulation

Abstract

In Parkinson's disease, dopamine dysregulation syndrome (DDS) is characterized by severe dopamine addiction and behavioral disorders such as manic psychosis, hypersexuality, pathological gambling, and mood swings. Here, we describe the case of 2 young parkinsonian patients suffering from disabling motor fluctuations and dyskinesia associated with severe DDS. In addition to alleviating the motor disability in both patients, subthalamic nucleus (STN) deep brain stimulation greatly reduced the behavioral disorders as well as completely abolished the addiction to dopaminergic treatment. Dopaminergic addiction in patients with Parkinson's disease, therefore, does not constitute an obstacle to high-frequency STN stimulation, and this treatment may even cure the addiction.

Alcohol Preference Influences the Subthalamic Nucleus Control on Motivation for Alcohol in Rats

“…This finding suggests that, more than dissociating between the motivation for natural reward and drugs of abuse , the STN seems to play a more complex role in the circuit of motivation. Furthermore, as HFS of the STN applied in human patients can lead to motivational effects in line with those observed after STN lesions in rats (Temel et al, 2006;Witjas et al, 2005), it would be very interesting to assess the effects of STN HFS on motivation for alcohol in patients. It may be also very critical to take into account the alcohol intake history of these Parkinsonian patients before implanting HFS electrodes.…”

“…It is now well established that the STN is involved in cognitive and motivational behavior both in rats and monkeys (Baunez et al, 2002Robbins, 1997, 1999;Darbaky et al, 2005;Winstanley et al, 2005) and in humans (Temel et al, 2006;Witjas et al, 2005). STN lesions can differentially modulate the motivation for natural reward and drugs of abuse.…”

“…The STN is, above all, currently known as a therapeutic target for Parkinson's disease treatment with high-frequency stimulation (HFS) (Limousin et al, 1995). Even if STN inactivation is used to alleviate motor symptoms (Benazzouz et al, 1993;Limousin et al, 1995), clinical and experimental studies have demonstrated that the STN is also involved in cognitive and motivational functions (Absher et al, 2000;Baunez et al, 1995;Baunez and Robbins, 1997;Temel et al, 2006;Trillet et al, 1995;Witjas et al, 2005). Only recently has the role of the STN on motivational processes been investigated.…”

Deep brain stimulation in Parkinson disease—what went wrong?

“…The STN and mood Depression, apathy and anxiety can arise as complications after surgery [60][61][62][63] and rare cases of acute stimulationinduced depressed mood have been reported [57,58]. However, the vast majority of cases with an acute emotional response to STN DBS exhibit hypomania [50] or mania [25,52].…”

“…More importantly, a systematic study of a large number of PD patients revealed a mood effect of acute STN DBS that corresponds to subjective wellbeing or euphoria, and not depression [23,59]. Single case reports have also shown that dysphoria during the off-medication period is improved by STN DBS [60][61][62]. Accumulated data from the literature is confusing on first sight, because postoperative mood outcome is influenced not only by STN DBS itself, but also by a reduction in medication, occasionally leading to a dopamine withdrawal syndrome with increases in anxiety, apathy and depression [63,64].…”