Impact of Subthalamic Deep Brain Stimulation on Impulse Control Disorders in Parkinson's Disease: A Prospective Study

Abstract

Background Impact of subthalamic deep brain stimulation (DBS) on impulse control disorders (ICD) in Parkinson's disease (PD) remains controversial. Objectives The objectives of this study were to analyze the natural history of ICD between baseline and 1 year after subthalamic DBS in patients with PD and to identify predictive factors, taking into account the positions of the active contact and stimulation parameters. Methods We analyzed postoperative modifications of ICD based on the multicentric, prospective Predictive Factors and Subthalamic Stimulation in Parkinson's Disease cohort. ICD status and Ardouin Scale of Behaviour in PD were assessed at baseline and 1 year following subthalamic DBS. Location of active contacts within the 3 subthalamic nucleus functional territories was investigated. Results A total of 217 were patients included. Of the patients, 10.6% had ICD at baseline of which 95.6% improved at 1 year following subthalamic DBS; 3.6% of the patients experienced de novo ICD at 1 year following subthalamic DBS. Dopamine agonist dose reduction (from 309.8 to 109.3 mg) was the main driver of ICD regression (P = 0.05). Higher preoperative dyskinesias were associated with poorer ICD evolution (P = 0.04). Whereas baseline apathy was a risk factor of de novo ICD (P = 0.02), ICD improvement correlated with postoperative apathy (P = 0.004). Stimulation power and position of active contacts—mainly located within the sensorimotor part of the subthalamic nucleus—did not influence ICD. Conclusions This 1‐year, postoperative follow‐up study showed ICD regression and dopaminergic drug reduction with optimal position of the active contacts within the subthalamic nucleus. Whereas patients with PD with preoperative ICD were prone to postoperative apathy, we also showed that those with preoperative apathy had a higher risk to experience postoperative de novo ICD, further highlighting the meaningful influence of postoperative management of dopaminergic medication on outcome and the continuum between apathy and ICD. © 2020 International Parkinson and Movement Disorder Society

Changing Gears – DBS For Dopaminergic Desensitization in Parkinson's Disease?

“…In the absence of a blinded RCT, the effect of chronic STN-DBS on ICD and DDS is estimated from several prospective studies and summaries of the available retrospective and prospective patient series. 6,76 Early case reports described improvements in dopamine addiction 77 and pathological gambling 78 in parallel to the postoperative decrease in dopaminergic medication. Since then, larger cohorts from several independent centers followed for periods of up to 7 years supported the overall beneficial long-term effect of STN-DBS on ICD.…”

“…Dopamine agonist dose reduction was the main driver of ICD improvement. 6,79 Desensitization consecutive to a decrease in dopaminergic medications, together with a decrease in ondrug euphoria, seemed to represent the basic mechanism. 15 Systematic improvement of ICD has not been reported in GPi-DBS, 80 which likely reflects the fact that GPi-DBS generally does not allow for a substantial decrease in dopaminergic medication.…”

“…However, the past two decades have seen an unprecedented growth in knowledge of the beneficial effects of DBS on motor and non-motor fluctuations, and the neuropsychiatric sequelae of dopaminergic treatment of PD relevant to QOL. [6][7][8] Here, we review the concept and consequences of dopaminergic sensitization, focusing on motor and neuropsychiatric domains. We will then evaluate the present state-of-the-art of DBS therapy to counteract dopaminergic complications.…”

Impulse Control Disorders in Parkinson’s Disease: From Bench to Bedside

“…Whether nonpharmacological interventions such as deep brain stimulation (DBS) ameliorates or worsens ICRBs in PD patients is still debated. While most human studies indicated that DBS improves PD + ICD, some have reported the development of shortterm de novo ICDs following DBS (Amami et al, 2015;Rossi et al, 2017;Kim et al, 2018;Lo Buono et al, 2020;Santin et al, 2020). In rodents, decreased risk-taking and losschasing was reported following lesioning to the subthalamic nucleus (STN), possibly pinpointing this region as a target for DBS and other treatments for PD + ICD (Breysse et al, 2020).…”

Tiefe Hirnstimulation beim idiopathischen Parkinson-Syndrom

“…Nicht alle ausgeprägten Psychopathologien stellen Kontraindikationen für die THS dar. Medikamentös induzierte psychische Symptome wie Impulskontrollstörungen oder Halluzinationen können -den Ausschluss einer Demenz vorausgesetzt -sogar eine Indikation für die THS darstellen, da diese Symptome im Zusammenhang mit der nach der THS möglichen Dosisreduktion der dopaminergen Medikation verschwinden oder sich dramatisch bessern können [18]. Neben einer Demenz kann eine schwere Depression eine Kontraindikation für die THS darstellen, insbesondere auch unter dem Gesichtspunkt einer (allerdings kontrovers diskutierten) erhöhten Suizidrate in den ersten Jahren nach THS, wobei prä operativ eine bestehende Depression einen Risikofaktor darstellt [19].…”