Merola Aristide, Romagnolo Alberto, Rizzi Laura, Rizzone Mario Giorgio, Zibetti Maurizio, Lanotte Michele, Mandybur George, Duker Andrew P, Espay Alberto J, Lopiano Leonardo
Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati (UC), 260 Stetson Street, Suite 4244, Cincinnati, OH, 45219, USA.
Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Turin, Italy.
J Neurol. 2017 Jan;264(1):40-48. doi: 10.1007/s00415-016-8314-x. Epub 2016 Oct 19.
To determine the clinical and demographic correlates of persistent, remitting, and new-onset impulse control behaviors (ICBs) before and after subthalamic deep brain stimulation (STN-DBS) in Parkinson's disease (PD). We compared the pre- and post-surgical prevalence of ICBs, classified as impulse control disorders (ICD), dopamine dysregulation syndrome (DDS), and punding in 150 consecutive PD STN-DBS-treated patients and determined the association with motor, cognitive, neuropsychological, and neuropsychiatric endpoints. At baseline (before STN-DBS), ICBs were associated with younger age (p = 0.045) and male gender (85 %; p = 0.001). Over an average follow-up of 4.3 ± 2.1 years of chronic STN-DBS there was an overall trend for reduction in ICBs (from 17.3 to 12.7 %; p = 0.095) with significant improvement in hypersexuality (12-8.0 %; p = 0.047), gambling (10.7-5.3 %; p = 0.033), and DDS (4.7-0 %; p < 0.001). ICB remitted in 18/26 patients (69 %) and persisted in 8/26 (31 %); the latter group was characterized by higher levodopa equivalent daily dose. Patients who developed a new-onset ICB during follow-up (n = 11/150) were characterized by younger age (p = 0.042), lower dyskinesia improvement (p ≤ 0.035), and a gender distribution with higher prevalence of women (p = 0.018). In addition, new-onset ICB was more common among patients with borderline, schizoid, and/or schizotypal traits of personality disorders; persistent ICB in those with obsessive-compulsive traits. PD-related ICBs exhibit a complex outcome after STN-DBS, with a tendency for overall reduction but with age, gender, dopaminergic therapy, and neuropsychiatric features exerting independent effects.
为确定帕金森病（PD）患者丘脑底核深部脑刺激（STN-DBS）前后持续性、缓解性和新发冲动控制行为（ICB）的临床及人口统计学相关因素。我们比较了150例接受STN-DBS治疗的连续性PD患者手术前后ICB的患病率，将ICB分为冲动控制障碍（ICD）、多巴胺调节障碍综合征（DDS）和刻板动作，并确定其与运动、认知、神经心理和神经精神终点的相关性。在基线期（STN-DBS前），ICB与较年轻的年龄（p = 0.045）和男性（85%；p = 0.001）相关。在平均4.3±2.1年的慢性STN-DBS随访中，ICB总体呈下降趋势（从17.3%降至12.7%；p = 0.095），其中性欲亢进（12%-8.0%；p = 0.047）、赌博（10.7%-5.3%；p = 0.033）和DDS（4.7%-0%；p < 0.001）有显著改善。26例患者中18例（69%）的ICB缓解，8例（31%）持续存在；后一组的特点是左旋多巴等效日剂量较高。随访期间出现新发ICB的患者（n = 11/150）的特点是年龄较轻（p = 0.042）、异动症改善较少（p≤0.035），且女性患病率较高的性别分布（p = 0.018）。此外，新发ICB在具有边缘性、分裂样和/或分裂型人格障碍特征的患者中更常见；持续性ICB在具有强迫性特征的患者中更常见。PD相关的ICB在STN-DBS后表现出复杂的结果，总体呈下降趋势，但年龄、性别、多巴胺能治疗和神经精神特征发挥独立作用。
