Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson's disease

Eusebio, Alexandre; Witjas, Tatiana; Cohen, Julien; Fluchère, Frédérique; Jouve, Élisabeth; Régis, Jean; Azulay, Jean‐Philippe

doi:10.1136/jnnp-2012-302387

Cited by 102 publications

(99 citation statements)

References 35 publications

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“…Patients with Parkinson's disease who are exposed to non-physiological dopaminergic stimulation are at high risk of developing a range of behavioural addictions or impulse control disorders. 88,89,91,122,154 By contrast, patients are at risk of developing apathy-an…”

Section: Discussionmentioning

confidence: 99%

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Pagonabarraga

Kulisevsky

Strafella

et al. 2015

The Lancet Neurology

420

394

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Normal maintenance of human motivation depends on the integrity of subcortical structures that link the prefrontal cortex with the limbic system. Structural and functional disruption of diff erent networks within these circuits alters the maintenance of spontaneous mental activity and the capacity of aff ected individuals to associate emotions with complex stimuli. The clinical manifestations of these changes include a continuum of abnormalities in goal-oriented behaviours known as apathy. Apathy is highly prevalent in Parkinson's disease (and across many neurodegenerative disorders) and can severely aff ect the quality of life of both patients and caregivers. Diff erentiation of apathy from depression, and discrimination of its cognitive, emotional, and auto-activation components could guide an individualised approach to the treatment of symptoms. The opportunity to manipulate dopaminergic treatment in Parkinson's disease allows researchers to study a continuous range of motivational states, from apathy to impulse control disorders. Parkinson's disease can thus be viewed as a model that provides insight into the neural substrates of apathy.

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Section: Discussionmentioning

confidence: 99%

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Pagonabarraga

Kulisevsky

Strafella

et al. 2015

The Lancet Neurology

420

394

View full text Add to dashboard Cite

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“…The outcomes for impulse control disorders and dopaminergic dysregulation syndrome after DBS are unpredictable: there are reports of ameliorated or worsened symptoms, and even the onset of novel impulse control disorders 41,42,43,44,45 . These so-called hyperdopaminergic behavioral manifestations could denote a background of susceptibility for psychiatric disorders and, even though some have reported good outcomes 44,45 , these effects may not materialize in the longterm 41,42,43 . In our experience, their presence should be viewed as a warning sign, and a case-by-case analysis is advised, taking into consideration other cognitive and behavioral comorbidities.…”

Section: Controversial Issues About Ineligibility Criteriamentioning

confidence: 99%

“…The anatomic configuration of the nucleus and its connections could, thus, explain these adverse effects over mood and behavior 26,60 . The effects of DBS over impulse control disorders are less predictable, with previous descriptions of resolution (partial or complete) and also emergence of new impulse control disorders 41,42,43,44,45 . The existence of impulse control disorders should be addressed in the presurgical assessments and attempts to treat these symptoms should be done before surgery 61 .…”

Section: Selection Of the Surgical Targetmentioning

confidence: 99%

Decisions about deep brain stimulation therapy in Parkinson’s disease

Brandão

Grippe²,

Modesto³

et al. 2018

Arq. Neuro-Psiquiatr.

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Parkinson' s disease (PD), a hypokinetic movement disorder characterized by the classic tetrad of bradykinesia, rest tremor, plastic rigidity, and postural disturbances 1,2 , is a neurodegenerative disorder with an increasing impact on the Brazilian social and healthcare system, mirroring known demographic-epidemiological changes such as aging of the population and widening of the apex of the age pyramid 3,4 . Considering a prevalence of 3.3% in those aged 65 or older in the Brazilian population 5 , the country has at least 200,000 patients living with the disorder, a definitive challenge to the public health system. ABSTRACTParkinson's disease can be treated surgically in patients who present with motor complications such as fluctuations and dyskinesias, or medically-refractory disabling tremor. In this review, a group of specialists formulated suggestions for a preoperative evaluation protocol after reviewing the literature published up to October 2017. In this protocol, eligibility and ineligibility criteria for surgical treatment were suggested, as well as procedures that should be carried out before the multidisciplinary therapeutic decisions. The review emphasizes the need to establish "DBS teams", with professionals dedicated specifically to this area. Finally, surgical target selection (subthalamic nucleus or globus pallidus internus) is discussed briefly, weighing the pros and cons of each target.Keywords: Parkinson disease; deep brain stimulation; reference standards; basal ganglia; neurosurgical procedures. RESUMOA doença de Parkinson pode ser tratada cirurgicamente em pacientes que desenvolveram complicações motoras, como flutuações e discinesias, ou tremores refratários ao uso de medicação. Nesta revisão, um grupo de especialistas formulou sugestões para um protocolo de avaliação pré-operatória, depois de revisar a literatura publicada até outubro de 2017. Neste protocolo, são sugeridos critérios de elegibilidade e inadmissibilidade para tratamento cirúrgico, bem como procedimentos que devem ser realizados antes das decisões terapêuticas multidisciplinares. A revisão enfatiza a necessidade de estabelecer "equipes de DBS", com profissionais dedicados especialmente a esta área. Ao final, a seleção do alvo cirúrgico (núcleo subtalâmico ou globo pálido interno) é discutida brevemente, ponderando prós e contras de cada escolha.Palavras-chave: doença de Parkinson; estimulação cerebral profunda; padrões de referência; gânglios da base; procedimentos neurocirúrgicos.

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“…La stimulation profonde du noyau sous-thalamique n'a pas encore été testée en première intention chez des sujets toxicomanes. En revanche, de manière intéressante, pour certains patients atteints de la maladie de Parkinson qui développent une prise compulsive et une dépendance à la L-DOPA en dépit de sévères effets secondaires (on parle alors de syndrome de dérégulation dopaminergique), la stimulation profonde du noyau sousthalamique a montré des effets bénéfiques sur leur addiction à la L-DOPA [28][29][30].…”

Section: Stimulation Profonde Du Noyau Sous-thalamiqueunclassified

La chirurgie au secours des addictions

Pelloux

Baunez

2015

Med Sci (Paris)

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> Initialement développée pour le traitement de pathologies neurologiques, comme la maladie de Parkinson, la stimulation cérébrale profonde est actuellement utilisée dans certaines pathologies psychiatriques telles que les troubles obsessionnels compulsifs ou la dépression. Elle commence à être envisagée, voire appliquée, comme traitement de certaines addictions. Nous faisons le point dans cette revue sur l'évolution des discussions sur l'intérêt de cette approche thérapeutique, et discutons en particulier les arguments expérimentaux orientant le choix vers les deux cibles cérébrales les plus pertinentes pour traiter les addictions par stimulation cérébrale profonde : le noyau accumbens (NAc) et le noyau sous-thalamique (NST). < tion de volonté. Cependant, certaines formes de dépendances peuvent être atténuées, voire stoppées, grâce à des substituts de la drogue (comme la méthadone utilisée dans les cas de dépendance aux opiacés). De même, les thérapies comportementales peuvent contribuer à un arrêt de la conduite toxicomaniaque. Dans le cas de l'alcool par exemple, une démarche actuellement débattue consiste à proposer à certains alcooliques non pas une attitude d'abstinence complète telle que prônée jusqu'à présent, mais une attitude de consommation contrôlée. L'abstinence complète était jusqu'à présent principalement recommandée en partant du principe qu'un individu addict restera vulnérable toute sa vie, et qu'il n'existe aucun traitement satisfaisant pour l'aider à maintenir une consommation contrôlée. Les progrès de la neurochirurgie appliquée aux maladies neurologiques comme la maladie de Parkinson, ont également permis un renouveau des approches chirurgicales appliquées aux maladies psychiatriques. Celles-ci étaient en effet devenues « tabou » à la suite des effets secondaires désastreux des lobotomies et autres chirurgies appliquées à la psychiatrie. Mais le développement de la stimulation cérébrale profonde (SCP) -qui a été utilisée récemment chez des patients souffrant de dépression sévère et résistante aux médicaments, mais égale-ment chez des patients souffrant de troubles obsessionnels compulsifs (TOC) [45] -a relancé la discussion sur l'intérêt d'une thérapeutique chirurgicale dans les addictions. Qu'est-ce que la stimulation cérébrale profonde ?La stimulation cérébrale profonde consiste en l'implantation d'une électrode dans une zone cérébrale déterminée et en l'application d'un courant, souvent à haute fréquence (130 Hz La dépendance à une drogue est une pathologie psychiatrique qui, pendant longtemps, n'a pas été considérée comme telle. En effet, l'addiction ne se résume pas au simple usage de drogue mais bien à une perte du contrôle de sa consommation et à une recherche compulsive et obsessionnelle de la substance. Elle est l'aboutissement d'une progression plus ou moins lente d'une consommation récréationnelle initiale, à une consommation abusive et enfin toxicomaniaque. Les travaux de recherche menés sur les conduites addictives ont montré que tous les individus ne sont pas égaux face à ce p...

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Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson's disease

Abstract: Our results suggest that STN DBS may reduce compulsive use of dopaminergic medication and its behavioural consequences. Whether this improvement is the result of STN DBS or the consequence of better treatment management remains to be established.

Cited by 102 publications

References 35 publications

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Decisions about deep brain stimulation therapy in Parkinson’s disease

La chirurgie au secours des addictions

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