Hälbig T D, Tse W, Frisina P G, Baker B R, Hollander E, Shapiro H, Tagliati M, Koller W C, Olanow C W
Fédération de Neurologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France.
Eur J Neurol. 2009 Apr;16(4):493-7. doi: 10.1111/j.1468-1331.2008.02509.x.
Experimental studies suggest that deep brain stimulation (DBS) of the subthalamic nucleus (STN) induces impulsivity in patients with Parkinson's disease (PD). The purpose of this study was to assess various measures of impulse control in PD patients with STN DBS in comparison to patients receiving medical therapy.
In a cross-sectional evaluation, 53 consecutively eligible patients were assessed for impulsivity with the Barratt Impulsiveness Scale, for impulse control disorders (ICDs) using the Minnesota Impulsive Disorders Interview, and for obsessive-compulsive symptoms using the Maudsley Obsessional-Compulsive Inventory.
Independent samples t-tests revealed that compulsivity scores were not different between DBS patients and patients without DBS. However, impulsivity scores were significantly higher in DBS patients. Additionally, ICDs were observed in 3 of 16 (19%) DBS patients and in 3 of 37 (8%) medically treated patients. No association was found between the use of dopamine agonists and impulsivity in DBS patients.
Our data suggest that screening for impulsivity and ICDs should be performed prior to DBS, and that patients should be monitored for these problems during follow-up. Prospective trials are needed to confirm the findings of this exploratory study and to elucidate the reasons of a possible induction of impulsivity by STN DBS.
实验研究表明，对帕金森病（PD）患者进行丘脑底核（STN）的深部脑刺激（DBS）会诱发冲动行为。本研究旨在评估接受STN-DBS治疗的PD患者与接受药物治疗的患者在冲动控制方面的各项指标。
在一项横断面评估中，连续纳入53例符合条件的患者，使用巴拉特冲动性量表评估冲动性，使用明尼苏达冲动障碍访谈评估冲动控制障碍（ICD），使用莫兹利强迫观念-强迫行为量表评估强迫症状。
独立样本t检验显示，DBS患者与未接受DBS治疗的患者在强迫性得分上无差异。然而，DBS患者的冲动性得分显著更高。此外，16例DBS患者中有3例（19%）出现ICD，37例接受药物治疗的患者中有3例（8%）出现ICD。在DBS患者中，未发现多巴胺激动剂的使用与冲动性之间存在关联。
我们的数据表明，在进行DBS之前应筛查冲动性和ICD，并且在随访期间应对患者的这些问题进行监测。需要进行前瞻性试验以证实本探索性研究的结果，并阐明STN-DBS可能诱发冲动性的原因。
