Course of Impulse Control Disorder Symptoms in Parkinson's Disease: Deep Brain Stimulation Versus Medications

Hernandez‐Con, Pilar; Lin, I. I.; Mamikonyan, Eugenia; Deeb, Wissam; Feldman, Robert; Althouse, Andrew D.; Barmore, Ryan; Eisinger, Robert S.; Spindler, Meredith; Okun, Michael S.; Weintraub, Daniel; Chahine, Lana M.

doi:10.1002/mdc3.13738

Cited by 2 publications

(4 citation statements)

References 36 publications

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“…We also found no differences in gender between ICD-positive patients, both among those suffering from PD and APS. There is no clearly defined influence of gender on ICDs in the literature, as some publications indicate male gender as a risk factor for ICDs in PD, while others do not find this correlation [43,63,64]. As for patients with APS like PSP, we did not find a similar correlation as well, and in MSA, the only patient with ICD was a woman.…”

Section: Discussioncontrasting

confidence: 80%

Impulse Control Disorders in Parkinson’s Disease and Atypical Parkinsonian Syndromes—Is There a Difference?

Toś,

Grażyńska,

Antoniuk

et al. 2024

Brain Sciences

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Background and Objectives: Impulse control disorders (ICDs) are characterized by potentially harmful actions resulting from disturbances in the self-control of emotions and behavior. ICDs include disorders such as gambling, hypersexuality, binge eating, and compulsive buying. ICDs are known non-motor symptoms in Parkinson’s disease (PD) and are associated primarily with the use of dopaminergic treatment (DRT) and especially dopamine agonists (DA). However, in atypical parkinsonism (APS), such as progressive supranuclear palsy (PSP) or multiple system atrophy (MSA), there are only single case reports of ICDs without attempts to determine the risk factors for their occurrence. Moreover, numerous reports in the literature indicate increased impulsivity in PSP. Our study aimed to determine the frequency of individual ICDs in APS compared to PD and identify potential factors for developing ICDs in APS. Materials and Methods: Our prospective study included 185 patients with PD and 35 with APS (27 patients with PSP and 9 with MSA) hospitalized between 2020 and 2023 at the Neurological Department of University Central Hospital in Katowice. Each patient was examined using the Questionnaire for Impulsive–Compulsive Disorders in Parkinson’s Disease (QUIP) to assess ICDs. Additionally, other scales were used to assess the advancement of the disease, the severity of depression, and cognitive impairment. Information on age, gender, age of onset, disease duration, and treatment used were collected from medical records and patient interviews. Results: ICDs were detected in 23.39% of patients with PD (including binge eating in 11.54%, compulsive buying in 10.44%, hypersexuality in 8.79%, and pathological gambling in 4.40%), in one patient with MSA (hypersexuality and pathological gambling), and in 18.52% of patients with PSP (binge eating in 3.70%, compulsive buying in 7.41%, and hypersexuality in 11.11%). We found no differences in the frequency of ICDs between individual diseases (p = 0.4696). We confirmed that the use of higher doses of DA and L-dopa in patients with PD, as well as a longer disease duration and the presence of motor complications, were associated with a higher incidence of ICDs. However, we did not find any treatment effect on the incidence of ICDs in APS. Conclusions: ICDs are common and occur with a similar frequency in PD and APS. Well-described risk factors for ICDs in PD, such as the use of DRT or longer disease duration, are not fully reflected in the risk factors for ICDs in APS. This applies especially to PSP, which, unlike PD and MSA, is a tauopathy in which, in addition to the use of DRT, other mechanisms related to the disease, such as disorders in neuronal loops and neurotransmitter deficits, may influence the development of ICDs. Further prospective multicenter studies recruiting larger groups of patients are needed to fully determine the risk factors and mechanisms of ICD development in APS.

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Section: Discussioncontrasting

confidence: 80%

Impulse Control Disorders in Parkinson’s Disease and Atypical Parkinsonian Syndromes—Is There a Difference?

Toś,

Grażyńska,

Antoniuk

et al. 2024

Brain Sciences

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“…5,83,84 However, some studies, including not only STN-DBS patients but also patients with unilateral STN-DBS and DBS of the globus pallidus internus (GPi), showed worsening of ICBDs in some patients (eg, Lim et al 92 ) or overallstable ICBDs. 85 In this context, it is important to mention that a decrease in dopaminergic medication, which might be the main driving factor for a decrease in ICBDs after bilateral STN-DBS, is less pronounced in patients with unilateral STN-DBS or GPi-DBS. Another factor influencing the results of these studies is the baseline occurrence of ICBDs (eg, low incidence of ICBDs at baseline leading to less overall improvement).…”

Section: Specific Treatments For Impulse-control and Related Behavior...mentioning

confidence: 99%

“…In conclusion, the majority of studies conducted so far confirm that ICBDs tend to decrease after bilateral STN‐DBS. In studies including patients with unilateral STN‐DBS and GPi‐DBS, the results are less clear, 85,92 but overall worsening of ICBDs is not common. However, further high‐quality evidence is needed to confirm if ICBDs improve after DBS and to identify what role the postoperative reduction in medication and stimulation itself plays.…”

Section: Introductionmentioning

confidence: 99%

“…Several prospective studies showed a reduction in ICBDs after bilateral STN‐DBS 5,83,84 . However, some studies, including not only STN‐DBS patients but also patients with unilateral STN‐DBS and DBS of the globus pallidus internus (GPi), showed worsening of ICBDs in some patients (eg, Lim et al 92 ) or overall‐stable ICBDs 85 . In this context, it is important to mention that a decrease in dopaminergic medication, which might be the main driving factor for a decrease in ICBDs after bilateral STN‐DBS, is less pronounced in patients with unilateral STN‐DBS or GPi‐DBS.…”

Section: Introductionmentioning

confidence: 99%

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Management of Impulse Control and Related Disorders in Parkinson's Disease: An Expert Consensus

Debove,

Paschen,

Amstutz

et al. 2024

Movement Disorders

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BackgroundImpulse‐control and related behavioral disorders (ICBDs) significantly impact the lives of Parkinson's disease (PD) patients and caregivers, with lasting consequences if undiagnosed and untreated. While ICBD pathophysiology and risk factors are well‐studied, a standardized severity definition and treatment evidence remain elusive.ObjectiveThis work aimed to establish international expert consensus on ICBD treatment strategies. To comprehensively address diverse treatment availabilities, experts from various continents were included.MethodsFrom 2021 to 2023, global movement disorders specialists engaged in a Delphi process. A core expert group initiated surveys, involving a larger panel in three iterations, leading to refined severity definitions and treatment pathways.ResultsExperts achieved consensus on defining ICBD severity, emphasizing regular PD patient screenings for early detection. General treatment recommendations focused on continuous monitoring, collaboration with significant others, and seeking specialist advice for legal or financial challenges. For mild to severe ICBDs, gradual reduction in dopamine agonists was endorsed, followed by reductions in other PD medications. Second‐line treatment strategies included diverse approaches like reversing the last medication change, cognitive behavior therapy, subthalamic nucleus deep brain stimulation, and specific medications like quetiapine, clozapine, and antidepressants. The panel reached consensus on distinct treatment pathways for punding and dopamine dysregulation syndrome, formulating therapy recommendations. Comprehensive discussions addressed management strategies for the exacerbation of either motor or non‐motor symptoms following the proposed treatments.ConclusionThe consensus offers in‐depth insights into ICBD management, presenting clear severity criteria and expert consensus treatment recommendations. The study highlights the critical need for further research to enhance ICBD management. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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Course of Impulse Control Disorder Symptoms in Parkinson's Disease: Deep Brain Stimulation Versus Medications

Cited by 2 publications

References 36 publications

Impulse Control Disorders in Parkinson’s Disease and Atypical Parkinsonian Syndromes—Is There a Difference?

Impulse Control Disorders in Parkinson’s Disease and Atypical Parkinsonian Syndromes—Is There a Difference?

Management of Impulse Control and Related Disorders in Parkinson's Disease: An Expert Consensus

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