Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy.
Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM-UPMC UMRS 975, IMMA, Fédération de Neurologie, AP-HP Hôpital de la Pitié-Salpêtrière, Paris, France.
J Neurol Neurosurg Psychiatry. 2015 Feb;86(2):186-90. doi: 10.1136/jnnp-2013-307146. Epub 2014 May 23.
Impulse control disorders (ICD), including pathological gambling, are common in Parkinson's disease (PD) and tend to improve after subthalamic (STN) stimulation after a marked reduction of dopaminergic medication. In order to investigate the effect of STN stimulation on impulsive decision making, we used the Iowa Gambling task (IGT).
We investigated IGT performance in 20 patients with PD before STN surgery with and without dopaminergic treatment and in 24 age-matched controls. All patients underwent an extensive neuropsychological interview screening for behavioural disorders. Assessment in patients was repeated 3 months after surgery without dopaminergic treatment with and without stimulation.
Chronic antiparkinsonian treatment was drastically reduced after surgery (-74%). At baseline, on high chronic dopaminergic treatment 8/20 patients with PD presented with pathological hyperdopaminergic behaviours, which had resolved in 7/8 patients 3 months after surgery on low chronic dopaminergic treatment. Preoperative performance on the IGT was significantly impaired compared to after surgery.
Dopaminergic medication likely contributes to the impairment in decision making underlying ICDs. Deep brain stimulation allows drastic reduction of dopaminergic medication and, thus, concomitant remediation of medication-induced impairment in decision making.
冲动控制障碍（ICD），包括病理性赌博，在帕金森病（PD）中很常见，并且在减少多巴胺能药物治疗后，通过丘脑底核（STN）刺激后往往会改善。为了研究 STN 刺激对冲动决策的影响，我们使用了爱荷华赌博任务（IGT）。
我们调查了 20 名 PD 患者在 STN 手术前和手术后（无多巴胺能治疗）以及 24 名年龄匹配的对照组的 IGT 表现。所有患者均接受了广泛的神经心理学访谈，以筛查行为障碍。在没有多巴胺能治疗的情况下，在手术后 3 个月再次对患者进行评估，同时评估有无刺激。
手术后，慢性抗帕金森病治疗急剧减少（-74%）。在基线时，8/20 名 PD 患者在高慢性多巴胺能治疗时表现出病理性的高多巴胺能行为，这些行为在手术后 3 个月低慢性多巴胺能治疗时已在 7/8 名患者中得到解决。与手术后相比，术前 IGT 表现明显受损。
多巴胺能药物治疗可能导致 ICD 相关决策障碍的损害。深部脑刺激允许大幅度减少多巴胺能药物治疗，从而同时纠正药物引起的决策障碍。
