University of Birmingham Medical School, Birmingham B152TT, UK.
Parkinsons Dis. 2011 Feb 20;2011:658415. doi: 10.4061/2011/658415.
Parkinson's disease (PD) has been associated with the development of impulse control disorders (ICDs), possibly due to overstimulation of the mesolimbic system by dopaminergic medication. Preliminary reports have suggested that deep brain stimulation (DBS), a neurosurgical procedure offered to patients with treatment-resistant PD, affects ICD in a twofold way. Firstly, DBS allows a decrease in dopaminergic medication and hence causes an improvement in ICDs. Secondly, some studies have proposed that specific ICDs may develop after DBS. This paper addresses the effects of DBS on ICDs in patients with PD. A literature search identified four original studies examining a total of 182 patients for ICDs and nine case reports of 39 patients that underwent DBS and developed ICDs at some point. Data analysis from the original studies did not identify a significant difference in ICDs between patients receiving dopaminergic medication and patients on DBS, whilst the case reports showed that 56% of patients undergoing DBS had poor outcome with regards to ICDs. We discuss these ambivalent findings in the light of proposed pathogenetic mechanisms. Longitudinal, prospective studies with larger number of patients are required in order to fully understand the role of DBS on ICDs in patients with PD.
帕金森病(PD)与冲动控制障碍(ICD)的发展有关,可能是由于多巴胺能药物对中脑边缘系统的过度刺激。初步报告表明,深部脑刺激(DBS)是一种为治疗抵抗性 PD 患者提供的神经外科手术,以双重方式影响 ICD。首先,DBS 允许减少多巴胺能药物,从而导致 ICD 改善。其次,一些研究提出特定的 ICD 可能在 DBS 后发展。本文探讨了 DBS 对 PD 患者 ICD 的影响。文献检索确定了四项原始研究,共检查了 182 例 ICD 患者,以及 9 例 39 例接受 DBS 并在某个时间点发生 ICD 的病例报告。原始研究的数据分析并未发现接受多巴胺能药物治疗的患者与接受 DBS 的患者之间 ICD 存在显著差异,而病例报告表明,56%的接受 DBS 的患者在 ICD 方面预后不佳。我们根据提出的发病机制讨论了这些矛盾的发现。需要进行更多患者的纵向、前瞻性研究,以充分了解 DBS 在 PD 患者 ICD 中的作用。