Knobel David, Aybek Selma, Pollo Claudio, Vingerhoets François J G, Berney Alexandre
Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
Cogn Behav Neurol. 2008 Sep;21(3):187-9. doi: 10.1097/WNN.0b013e318185e6e2.
To describe how subthalamic deep brain stimulation (STN-DBS) and reduction in dopamine replacement therapy (DRT) allowed rapid resolution of dopamine dysregulation syndrome (DDS) with severe behavioral disorder in a patient with late stage Parkinson disease (PD).
DDS was recently defined as compulsive use of dopaminergic drugs, associated with severe behavioral symptoms, and impaired social functioning, occurring in about 4% of PD patients under DRT. STN-DBS is an effective treatment for late stage PD with treatment resistant motor fluctuations, which frequently allows also to reduce DRT.
A late stage PD patient referred to our center for STN-DBS, suffering from severe DDS necessitating in-ward psychiatric management, was comprehensively assessed preoperatively and postoperatively for motor, cognitive, and psychiatric status.
Following subthalamic DBS procedure and medication reduction, we observed a rapid and dramatic resolution of DDS and associated psychiatric symptoms, allowing discharge from a 2-year stay in a psychiatric institution.
DDS occurring in late stage PD patients may be dramatically improved by STN-DBS, possibly in relation with the reduction of dopaminergic medication. In contrast to other psychiatric symptoms, DDS should not be considered as an obstacle to DBS procedure in late stage PD patients.
描述丘脑底核深部脑刺激（STN-DBS）及多巴胺替代疗法（DRT）减量如何使一名晚期帕金森病（PD）患者的多巴胺失调综合征（DDS）伴严重行为障碍迅速得到缓解。
DDS最近被定义为多巴胺能药物的强迫性使用，伴有严重行为症状和社会功能受损，约4%接受DRT的PD患者会出现这种情况。STN-DBS是治疗伴有治疗抵抗性运动波动的晚期PD的有效方法，通常还能使DRT减量。
一名因STN-DBS转诊至我们中心的晚期PD患者，患有严重DDS，需要住院精神科治疗，术前和术后对其运动、认知和精神状态进行了全面评估。
在进行丘脑底核DBS手术及减少药物治疗后，我们观察到DDS及相关精神症状迅速且显著缓解，该患者得以从精神病院两年的住院治疗中出院。
晚期PD患者出现的DDS可能通过STN-DBS得到显著改善，这可能与多巴胺能药物治疗的减少有关。与其他精神症状不同，DDS不应被视为晚期PD患者进行DBS手术的障碍。
