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Impulse control behaviors and subthalamic deep brain stimulation in Parkinson disease

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Abstract

To determine the clinical and demographic correlates of persistent, remitting, and new-onset impulse control behaviors (ICBs) before and after subthalamic deep brain stimulation (STN-DBS) in Parkinson’s disease (PD). We compared the pre- and post-surgical prevalence of ICBs, classified as impulse control disorders (ICD), dopamine dysregulation syndrome (DDS), and punding in 150 consecutive PD STN-DBS-treated patients and determined the association with motor, cognitive, neuropsychological, and neuropsychiatric endpoints. At baseline (before STN-DBS), ICBs were associated with younger age (p = 0.045) and male gender (85 %; p = 0.001). Over an average follow-up of 4.3 ± 2.1 years of chronic STN-DBS there was an overall trend for reduction in ICBs (from 17.3 to 12.7 %; p = 0.095) with significant improvement in hypersexuality (12–8.0 %; p = 0.047), gambling (10.7–5.3 %; p = 0.033), and DDS (4.7–0 %; p < 0.001). ICB remitted in 18/26 patients (69 %) and persisted in 8/26 (31 %); the latter group was characterized by higher levodopa equivalent daily dose. Patients who developed a new-onset ICB during follow-up (n = 11/150) were characterized by younger age (p = 0.042), lower dyskinesia improvement (p ≤ 0.035), and a gender distribution with higher prevalence of women (p = 0.018). In addition, new-onset ICB was more common among patients with borderline, schizoid, and/or schizotypal traits of personality disorders; persistent ICB in those with obsessive–compulsive traits. PD-related ICBs exhibit a complex outcome after STN-DBS, with a tendency for overall reduction but with age, gender, dopaminergic therapy, and neuropsychiatric features exerting independent effects.

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Acknowledgments

Authors acknowledge the contributions of the Neurology Unit staff at the San Giovanni Battista Hospital, Turin and the Gardner Family Center for Parkinson’s Disease and Movement Disorders at the University of Cincinnati.

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Authors and Affiliations

  1. Department of Neurology, Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati (UC), 260 Stetson Street, Suite 4244, Cincinnati, OH, 45219, USA

    Aristide Merola, Andrew P. Duker & Alberto J. Espay

  2. Department of Neuroscience “Rita Levi Montalcini”, University of Turin, via Cherasco 15, 10124, Turin, Italy

    Alberto Romagnolo, Laura Rizzi, Mario Giorgio Rizzone, Maurizio Zibetti, Michele Lanotte & Leonardo Lopiano

  3. Department of Neurosurgery, Neuroscience Institute and UC College of Medicine, University of Cincinnati (UC), Cincinnati, OH, USA

    George Mandybur

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  1. Aristide Merola
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  2. Alberto Romagnolo
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Correspondence to Aristide Merola.

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Conflicts of interest

Dr. Merola has received grant support from UCB Pharma and speaker honoraria from CSL Behring, UCB Pharma and Teva Pharmaceuticals. He has received personal compensation from Edge Consulting S.r.l., MediK S.r.l. and Sthetos S.r.l. Dr. Romagnolo has received grant support from AbbVie and travel grants from Novartis and Merck Serono. He has received personal compensation from Edge Consulting S.r.l. and Sthetos S.r.l. Dr. Rizzi declares no conflicts of interests. Dr. Rizzone received speaker and/or consulting honoraria from Medtronic, Lundbeck, UCB Pharma and AbbVie. Dr. Zibetti received speaker and/or consulting honoraria from Medtronic, Lundbeck, UCB Pharma and AbbVie. Prof. Lanotte received honoraria for lecturing and travel grants from Medtronic. Dr. Duker has served as a consultant for Merz Pharmaceuticals, US World Meds, and Auspex Pharmaceuticals and has received honoraria from UCB. Dr. Mandybur received honoraria for lecturing and travel grants from Medtronic. Dr. Espay is supported by the NIH (K23MH092735) and has received grant support from CleveMed/Great Lakes Neurotechnologies, Davis Phinney Foundation, and Michael J Fox Foundation; personal compensation as a consultant/scientific advisory board member for Solvay, Abbott, Chelsea Therapeutics, TEVA, Impax, Merz, Lundbeck, and Eli Lilly; honoraria from TEVA, UCB, the American Academy of Neurology, and the Movement Disorders Society; and publishing royalties from Lippincott Williams & Wilkins and Cambridge University Press. Prof. Lopiano received honoraria for lecturing and travel grants from Medtronic, UCB Pharma and AbbVie.

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Nothing to declare.

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The authors declare that they acted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. The ethical committees approval was obtained (Comitato Etico Interaziendale Città della Salute e della Scienza di Torino; CS/855; Prot. no. 475/2016) and all patients gave their written informed consent to participate at the study.

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Merola, A., Romagnolo, A., Rizzi, L. et al. Impulse control behaviors and subthalamic deep brain stimulation in Parkinson disease. J Neurol 264, 40–48 (2017). https://doi.org/10.1007/s00415-016-8314-x

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