Clinical aspects of impulsive compulsive behaviours in Parkinson's disease

Djamshidian, Atbin; Averbeck, Bruno B.; Lees, Andrew J.; O’Sullivan, Sean S.

doi:10.1016/j.jns.2011.07.031

Cited by 40 publications

(30 citation statements)

References 91 publications

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“…On the other hand, several studies have reported no improvement, worsening of pre-existing behavioural addictions (Lim et al, 2009) Lim et al, 2009;De la Casa-Fages and Grandas, 2011). Authors usually argue that the worsening is mainly related to electrode position and spread of stimulation effects into the limbic portion of the STN (Djamshidian et al, 2011). However, as we had no single new occurrence of impulse control disorder, with the single exception of a patient with severe restless legs syndrome not allowing arrest of dopamine agonist (see Case 2, Supplementary material), we believe that management of medication and stimulation parameters are the main explanatory factors.…”

Section: Improvement Of Dopamine Dysregulation Syndrome Behavioural mentioning

confidence: 99%

Subthalamic stimulation in Parkinson’s disease: restoring the balance of motivated behaviours

Lhommée

Klinger

Thobois

et al. 2012

Brain

246

287

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Addictions to dopaminergic drugs or to pleasant behaviours are frequent and potentially devastating neuropsychiatric disorders observed in Parkinson's disease. They encompass impulse control disorders, punding and dopamine dysregulation syndrome. A relationship with dopaminergic treatment is strongly suggested. Subthalamic stimulation improves motor complications and allows for drastic reductions in medication. This treatment might, therefore, be considered for patients with behavioural addictions, when attempts to reduce dopaminergic medication have failed. However, conflicting data have reported suppression, alleviation, worsening or new onset of behavioural addictions after subthalamic stimulation. Non-motor fluctuations are also a disabling feature of the disease. We prospectively investigated behaviour in a cohort of 63 patients with Parkinson's disease, before and 1 year after subthalamic stimulation using the Ardouin scale, with systematic evaluation of functioning in overall appetitive or apathetic modes, non-motor fluctuations, dopaminergic dysregulation syndrome, as well as behavioural addictions (including impulse control disorders and punding) and compulsive use of dopaminergic medication. Defined drug management included immediate postoperative discontinuation of dopamine agonists and reduction in levodopa. Motor and cognitive statuses were controlled (Unified Parkinson's Disease Rating Scale, Mattis Dementia Rating Scale, frontal score). After surgery, the OFF medication motor score improved ( À 45.2%), allowing for a 73% reduction in dopaminergic treatment, while overall cognitive evaluation was unchanged. Preoperative dopamine dysregulation syndrome had disappeared in 4/4, behavioural addictions in 17/17 and compulsive dopaminergic medication use in 9/9 patients. New onset of levodopa abuse occurred in one patient with surgical failure. Non-motor fluctuations were significantly reduced with improvements in off-dysphoria (P 4 0.001) and reduction in on-euphoria (P 4 0.001). There was an inversion in the number of patients functioning in an overall appetitive mode (29 before versus 2 after surgery, P 4 0.0001) to an overall apathetic mode (3 before versus 13 after surgery, P 5 0.05). Two patients attempted suicide. Improvement in motor fluctuations is linked to the direct effect of stimulation on the sensory-motor subthalamic territory, while improvement in dyskinesias is mainly explained by an indirect effect related to the decrease in dopaminergic drugs. Our data suggest that non-motor fluctuations could similarly be directly alleviated through stimulation of the non-motor subthalamic territories, and hyperdopaminergic side effects might improve mainly due to the decrease in dopaminergic medication. We show an overall improvement in neuropsychiatric symptomatology and propose that disabling non-motor fluctuations, dopaminergic treatment abuse and drug-induced behavioural addictions in Parkinson's disease may be considered as new indications for subthalamic stimulation.

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Section: Improvement Of Dopamine Dysregulation Syndrome Behavioural mentioning

confidence: 99%

Subthalamic stimulation in Parkinson’s disease: restoring the balance of motivated behaviours

Lhommée

Klinger

Thobois

et al. 2012

Brain

246

287

View full text Add to dashboard Cite

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“…Recently, many studies have reported the significance of cortisol detection and its correlation with different diseases. 3,7,[10][11][12][13] Therefore, diurnal cortisol detection in the laboratory and at the point of care (POC) has a great impact in monitoring sensitized/ altered human behavior. 11,12 Diurnal cortisol circadian rhythm is affected by schedule/activity and psychological/emotional stress of individuals.…”

Section: Introductionmentioning

confidence: 99%

Electrochemical sensing method for point-of-care cortisol detection in human immunodeficiency virus-infected patients

Yndart

Jayant

Sagar

et al. 2015

IJN

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A novel electrochemical sensing method was devised for the first time to detect plasma cortisol, a potential psychological stress biomarker, in human immunodeficiency virus (HIV)-positive subjects. A miniaturized potentiostat (reconfigured LMP91000 chip) interfaced with a microfluidic manifold containing a cortisol immunosensor was employed to demonstrate electrochemical cortisol sensing. This fully integrated and optimized electrochemical sensing device exhibited a wide cortisol-detection range from 10 pg/mL to 500 ng/mL, a low detection limit of 10 pg/mL, and sensitivity of 5.8 μA (pg mL) −1 , with a regression coefficient of 0.995. This cortisol-selective sensing system was employed to estimate plasma cortisol in ten samples from HIV patients. The electrochemical cortisol-sensing performance was validated using an enzyme-linked immunosorbent assay technique. The results obtained using both methodologies were comparable within 2%–5% variation. The information related to psychological stress of HIV patients can be correlated with disease-progression parameters to optimize diagnosis, therapeutic, and personalized health monitoring.

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“…Its abuse in PD patients is a well-recognized phenomenon and has been referred to as hedonistic homeostatic dysregulation 5 and dopamine dysregulation syndrome by various authors to avoid the stigmatizing label of addiction 6 . Its prevalence in PD is thought to be around 4% 7 in tertiary care setting. It has been discussed and debated whether it can actually be a drug of abuse given its dependence is largely iatrogenic rather than recreational 8. There have only been a few reports of L-Dopa abuse in non-PD setting which is rather surprising, given its potential addictive properties 9 , and might indicate the complexities that underlie that neurobiology of addiction.…”

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confidence: 99%