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doi: 10.1371/journal.pone.0029768. Epub 2012 Jan 25.

Effects of STN and GPi deep brain stimulation on impulse control disorders and dopamine dysregulation syndrome

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Effects of STN and GPi deep brain stimulation on impulse control disorders and dopamine dysregulation syndrome

Sarah J Moum et al. PLoS One.2012.

Abstract

Objective: Impulse control disorders (ICDs) and dopamine dysregulation syndrome (DDS) are important behavioral problems that affect a subpopulation of patients with Parkinson's disease (PD) and typically result in markedly diminished quality of life for patients and their caregivers. We aimed to investigate the effects of subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) on ICD/DDS frequency and dopaminergic medication usage.

Methods: A retrospective chart review was performed on 159 individuals who underwent unilateral or bilateral PD DBS surgery in either STN or GPi. According to published criteria, pre- and post-operative records were reviewed to categorize patients both pre- and post-operatively as having ICD, DDS, both ICD and DDS, or neither ICD nor DDS. Group differences in patient demographics, clinical presentations, levodopa equivalent dose (LED), and change in diagnosis following unilateral/bilateral by brain target (STN or GPi DBS placement) were examined.

Results: 28 patients met diagnostic criteria for ICD or DDS pre- or post-operatively. ICD or DDS classification did not differ by GPi or STN target stimulation. There was no change in DDS diagnosis after unilateral or bilateral stimulation. For ICD, diagnosis resolved in 2 of 7 individuals after unilateral or bilateral DBS. Post-operative development of these syndromes was significant; 17 patients developed ICD diagnoses post-operatively with 2 patients with pre-operative ICD developing DDS post-operatively.

Conclusions: Unilateral or bilateral DBS did not significantly treat DDS or ICD in our sample, even though a few cases of ICD resolved post-operatively. Rather, our study provides preliminary evidence that DDS and ICD diagnoses may emerge following DBS surgery.

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Conflict of interest statement

Competing Interests:MO serves as a consultant for the National Parkinson Foundation, and has received research grants from National Institutes of Health (NIH), National Parkinson Foundation, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, and the University of Florida Foundation. MO currently receives no support >24 months from industry. MO has received royalties for publications with Demos, Manson, and Cambridge (movement disorders books). MO has participated in CME activities on movement disorders sponsored by the University of South Florida CME office, PeerView, and by Vanderbilt University. The institution and not the PI receives grants from Medtronic and ANS/St. Jude, and the PI has no financial interest in these grants. MO has participated as a site PI and/or co-PI for several NIH, foundation, and industry sponsored trials over the years but has not received honoraria. This does not alter the authors adherence to all the PLoS ONE policies on sharing data and materials.

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