Department of Neurology, Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America.
PLoS One. 2012;7(1):e29768. doi: 10.1371/journal.pone.0029768. Epub 2012 Jan 25.
Impulse control disorders (ICDs) and dopamine dysregulation syndrome (DDS) are important behavioral problems that affect a subpopulation of patients with Parkinson's disease (PD) and typically result in markedly diminished quality of life for patients and their caregivers. We aimed to investigate the effects of subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) on ICD/DDS frequency and dopaminergic medication usage.
A retrospective chart review was performed on 159 individuals who underwent unilateral or bilateral PD DBS surgery in either STN or GPi. According to published criteria, pre- and post-operative records were reviewed to categorize patients both pre- and post-operatively as having ICD, DDS, both ICD and DDS, or neither ICD nor DDS. Group differences in patient demographics, clinical presentations, levodopa equivalent dose (LED), and change in diagnosis following unilateral/bilateral by brain target (STN or GPi DBS placement) were examined.
28 patients met diagnostic criteria for ICD or DDS pre- or post-operatively. ICD or DDS classification did not differ by GPi or STN target stimulation. There was no change in DDS diagnosis after unilateral or bilateral stimulation. For ICD, diagnosis resolved in 2 of 7 individuals after unilateral or bilateral DBS. Post-operative development of these syndromes was significant; 17 patients developed ICD diagnoses post-operatively with 2 patients with pre-operative ICD developing DDS post-operatively.
Unilateral or bilateral DBS did not significantly treat DDS or ICD in our sample, even though a few cases of ICD resolved post-operatively. Rather, our study provides preliminary evidence that DDS and ICD diagnoses may emerge following DBS surgery.
冲动控制障碍（ICD）和多巴胺调节障碍综合征（DDS）是影响帕金森病（PD）患者亚群的重要行为问题，通常会显著降低患者及其照顾者的生活质量。我们旨在研究丘脑底核（STN）和内苍白球（GPi）深部脑刺激（DBS）对 ICD/DDS 频率和多巴胺能药物使用的影响。
对 159 名在 STN 或 GPi 单侧或双侧接受 PD DBS 手术的个体进行了回顾性图表审查。根据已发表的标准，对术前和术后记录进行了回顾，以将患者在术前和术后分类为患有 ICD、DDS、ICD 和 DDS 两者或两者均无。检查了患者人口统计学特征、临床表现、左旋多巴等效剂量（LED）以及单侧/双侧脑靶点（STN 或 GPi DBS 放置）后诊断变化之间的组间差异。
28 名患者术前或术后符合 ICD 或 DDS 的诊断标准。GPi 或 STN 目标刺激的 ICD 或 DDS 分类没有差异。单侧或双侧刺激后 DDS 诊断没有改变。对于 ICD，7 名患者中的 2 名在单侧或双侧 DBS 后诊断得到解决。这些综合征的术后发展是显著的；17 名患者术后出现 ICD 诊断，其中 2 名术前患有 ICD 的患者术后出现 DDS。
在我们的样本中，单侧或双侧 DBS 并没有显著治疗 DDS 或 ICD，尽管少数 ICD 病例在术后得到解决。相反，我们的研究提供了初步证据，表明 DDS 和 ICD 诊断可能在 DBS 手术后出现。
