Subthalamic stimulation in Parkinson's disease: restoring the balance of motivated behaviours
| Autor: | Magaly Aya Kombo, Valérie Fraix, Eugénie Lhommée, Eric Seigneuret, Stephan Chabardes, Sebastien Carnicella, Jean-Louis Quesada, Stéphane Thobois, Paul Krack, Jean-Luc Bosson, Patrick Mertens, Alim-Louis Benabid, Emmanuelle Schmitt, Hélène Klinger, Jing Xie, Andrea Kistner, Amélie Bichon, Claire Ardouin, Emmanuel Broussolle, Gustavo Polo, Pierre Pollak |
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| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Levodopa Dyskinesia Drug-Induced Parkinson's disease Deep Brain Stimulation Impulse Control Disorders/etiology/therapy Neuropsychological Tests Severity of Illness Index Statistics Nonparametric Antiparkinson Agents Cohort Studies Physical medicine and rehabilitation Dopamine Subthalamic Nucleus Punding Deep Brain Stimulation/methods medicine Humans Apathy Psychiatry Dopamine dysregulation syndrome Aged Psychiatric Status Rating Scales Motivation Dopaminergic Parkinson Disease Parkinson Disease/complications/therapy Middle Aged medicine.disease ddc:616.8 Disruptive Impulse Control and Conduct Disorders Motivation/drug effects/physiology Subthalamic Nucleus/physiology Dyskinesia Dyskinesia Drug-Induced/etiology/therapy Levodopa/adverse effects/therapeutic use Female Neurology (clinical) Antiparkinson Agents/adverse effects medicine.symptom Psychology medicine.drug |
| Zdroj: | Brain, Vol. 135, No Pt 5 (2012) pp. 1463-77 |
| ISSN: | 0006-8950 |
| Popis: | Addictions to dopaminergic drugs or to pleasant behaviours are frequent and potentially devastating neuropsychiatric disorders observed in Parkinson's disease. They encompass impulse control disorders, punding and dopamine dysregulation syndrome. A relationship with dopaminergic treatment is strongly suggested. Subthalamic stimulation improves motor complications and allows for drastic reductions in medication. This treatment might, therefore, be considered for patients with behavioural addictions, when attempts to reduce dopaminergic medication have failed. However, conflicting data have reported suppression, alleviation, worsening or new onset of behavioural addictions after subthalamic stimulation. Non-motor fluctuations are also a disabling feature of the disease. We prospectively investigated behaviour in a cohort of 63 patients with Parkinson's disease, before and 1 year after subthalamic stimulation using the Ardouin scale, with systematic evaluation of functioning in overall appetitive or apathetic modes, non-motor fluctuations, dopaminergic dysregulation syndrome, as well as behavioural addictions (including impulse control disorders and punding) and compulsive use of dopaminergic medication. Defined drug management included immediate postoperative discontinuation of dopamine agonists and reduction in levodopa. Motor and cognitive statuses were controlled (Unified Parkinson's Disease Rating Scale, Mattis Dementia Rating Scale, frontal score). After surgery, the OFF medication motor score improved (-45.2%), allowing for a 73% reduction in dopaminergic treatment, while overall cognitive evaluation was unchanged. Preoperative dopamine dysregulation syndrome had disappeared in 4/4, behavioural addictions in 17/17 and compulsive dopaminergic medication use in 9/9 patients. New onset of levodopa abuse occurred in one patient with surgical failure. Non-motor fluctuations were significantly reduced with improvements in off-dysphoria (P ≤ 0.001) and reduction in on-euphoria (P ≤ 0.001). There was an inversion in the number of patients functioning in an overall appetitive mode (29 before versus 2 after surgery, P ≤ 0.0001) to an overall apathetic mode (3 before versus 13 after surgery, P |
| Databáze: | OpenAIRE |
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