Medications, Deep Brain Stimulation, and Other Factors Influencing Impulse Control Disorders in Parkinson's Disease

Abstract

Impulse control disorders (ICDs) in Parkinson's disease (PD) have a high cumulative incidence and negatively impact quality of life. ICDs are influenced by a complex interaction of multiple factors. Although it is now well-recognized that dopaminergic treatments and especially dopamine agonists underpin many ICDs, medications alone are not the sole cause. Susceptibility to ICD is increased in the setting of PD. While causality can be challenging to ascertain, a wide range of modifiable and non-modifiable risk factors have been linked to ICDs. Common characteristics of PD patients with ICDs have been consistently identified across many studies; for example, males with an early age of PD onset and dopamine agonist use have a higher risk of ICD. However, not all cases of ICDs in PD can be directly attributable to dopamine, and studies have concluded that additional factors such as genetics, smoking, and/or depression may be more predictive. Beyond dopamine, other ICD associations have been described but remain difficult to explain, including deep brain stimulation surgery, especially in the setting of a reduction in dopaminergic medication use. In this review, we will summarize the demographic, genetic, behavioral, and clinical contributions potentially influencing ICD onset in PD. These associations may inspire future preventative or therapeutic strategies.

The effect on deep brain stimulation of subthalamic nucleus and dopaminergic treatment in Parkinson disease

“…Beyond dopamine and DBS other pertinent risk factors have been identified and include gender, country of residence, age of PD onset, disease duration, alcohol/tobacco use, family history of impulsivity, genetic factors, non-dopaminergic medications, deep brain stimulation, personality traits, and more. [ 3 ]…”

“…[ 1 , 2 ] It comprises a class of psycho-behavioral disorders influenced by a complex interaction of multiple factors that negatively impact quality of life (QoL). [ 3 ]…”

Use of high-density EEG in patients with Parkinson's disease treated with deep brain stimulation

“…So, based on the above evidence, we plan to use HD EEG to anticipate changes in cerebral cortex activity related to STN DBS stimulation 8 . The results of HD EEG examination will be further processed and will help to create a cortical map of bioelectric potentials with a possibility to evaluate changes of connectivity, both between individual areas of the cerebral cortex, or in relation to neurostimulation in PD patients treated with DBS (comparison of states with DBS stimulation turned on and off), as already proven 9 . Comparison of results of these examinations may allow us to assess the effect of DBS on cortical functions by demonstrating a change in connectivity.…”

Pavlovian bias in Parkinson’s disease: an objective marker of impulsivity that modulates with deep brain stimulation

“…A fundamental, evolutionary purpose of the brain is to determine whether an organism should approach or avoid stimuli in the environment 1 . Failure during this process occurs in numerous neuropsychiatric diseases, including Parkinson's disease (PD), and can manifest as one or more impulse control disorders (ICDs)-for example, pathological gambling, hypersexuality, binge eating, compulsive shopping, and hobbyism 2,3 . Among PD patients, ICDs are frequent and underdiagnosed 4,5 .…”

“…That is, an individual is more likely to act to obtain a reward than to avoid a punishment (action-reward bias); open 1 Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL 32611, USA. 2 Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA. 3 Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.…”