Department of Psychiatry, University of Oxford, South Parks Road, Oxford, OX1 3UD, United Kingdom.
Exp Neurol. 2011 Sep;231(1):181-9. doi: 10.1016/j.expneurol.2011.06.007. Epub 2011 Jun 25.
Dopaminergic treatments are associated with impulse control disorders such as pathological gambling in a subset of patients with Parkinson's Disease. While deep brain stimulation of the subthalamic nucleus has been reported to reduce symptoms of impulse control disorders in some Parkinson's Disease patients, little is known about its specific effects on gambling behaviour. In this experiment, we investigated the effects of deep brain stimulation of the subthalamic nucleus on one of the central features of pathological gambling: the tendency to chase losses. Loss-chasing is associated with impaired control over gambling behaviour and it is one of the most salient features of pathological gambling as it presents in the clinic. Twenty two patients with advanced idiopathic Parkinson's Disease and chronically implanted subthalamic nucleus electrodes for deep brain stimulation completed a simple laboratory model of loss-chasing behaviour twice: once with and once without stimulation. Exploratory analysis indicated that deep brain stimulation of the subthalamic nucleus increased the value of losses chased by patients with Parkinson's Disease when shifting from off- to on-stimulation. These effects were not attributable to changes in state affect or to the motor impairments produced by the withdrawal of deep brain stimulation of the subthalamic nucleus. The effects of the stimulation on the value of losses chased were more pronounced in female than in male patients and reduced in patients taking dopamine receptor agonists. Collectively, these results suggest that deep brain stimulation of the subthalamic nucleus can transiently alter the evaluation of accumulated losses during gambling episodes in idiopathic Parkinson's Disease.
多巴胺能治疗与冲动控制障碍有关，如病理性赌博，在帕金森病患者的亚组。虽然已经报道了丘脑下核的深部脑刺激可以减少一些帕金森病患者冲动控制障碍的症状，但对于其对赌博行为的具体影响知之甚少。在这项实验中，我们研究了丘脑下核深部脑刺激对病理性赌博的一个核心特征的影响：追逐损失的倾向。损失追逐与对赌博行为的控制受损有关，这是病理性赌博最显著的特征之一，因为它在临床上表现出来。22 名患有晚期特发性帕金森病且长期植入丘脑下核电极进行深部脑刺激的患者两次完成了一个简单的损失追逐行为实验室模型：一次是在刺激开启时，一次是在刺激关闭时。探索性分析表明，当从关闭刺激切换到开启刺激时，丘脑下核深部脑刺激增加了帕金森病患者追逐损失的价值。这些影响不是由于状态影响的变化或由于丘脑下核深部脑刺激的撤回所产生的运动障碍。刺激对追逐损失价值的影响在女性患者中比男性患者更为明显，在服用多巴胺受体激动剂的患者中则降低。总的来说，这些结果表明，丘脑下核深部脑刺激可以在特发性帕金森病的赌博发作期间短暂改变对累积损失的评估。
