Adam Robert J, McLeod Robert, Ha Ainhi D, Colebatch James G, Menzies Graham, de Moore Gregory, Mahant Neil, Fung Victor S C
Movement Disorders Unit Department of Neurology Westmead Hospital Sydney Australia.
Westmead Clinical School University of Sydney Sydney Australia.
Mov Disord Clin Pract. 2014 Sep 16;1(4):357-360. doi: 10.1002/mdc3.12084. eCollection 2014 Dec.
Psychiatric symptoms are historically thought a relative contraindication to DBS for advanced Parkinson's disease (PD). However, in the case of drug-induced mental illness, DBS may provide an acceptable alternative for the treatment of motor symptoms. This allows reduction of pharmacological dopaminergic therapy that might otherwise cause negative psychiatric consequences. For example, DBS is increasingly used to ameliorate specific complications of PD , such as impulse control disorders. We present a series of 3 cases of young male patients who developed Othello syndrome (OS) during treatment with dopamine agonists. In each case, the OS resolved with withdrawal of the offending drug. Subsequent treatment with bilateral STN DBS improved motor symptoms and allowed reduction in their dopaminergic drug regimen. We therefore propose that drug-induced psychopathology may be an indication (rather than a contraindication) for DBS in selected cases.
从历史上看，精神症状被认为是晚期帕金森病（PD）进行脑深部电刺激（DBS）的相对禁忌证。然而，对于药物性精神疾病，DBS可能为运动症状的治疗提供一种可接受的替代方法。这使得可以减少可能会导致负面精神后果的多巴胺能药物治疗。例如，DBS越来越多地用于改善帕金森病的特定并发症，如冲动控制障碍。我们报告了3例年轻男性患者，他们在使用多巴胺激动剂治疗期间出现了奥赛罗综合征（OS）。在每例患者中，停用致病药物后OS症状均得到缓解。随后进行双侧丘脑底核DBS治疗改善了运动症状，并减少了多巴胺能药物治疗方案。因此，我们提出在某些特定情况下，药物性精神病理学可能是DBS治疗的一个适应证（而非禁忌证）。
