Matsuda Nozomu, Kobayashi Shunsuke, Ugawa Yoshikazu
Department of Neurology, Fukushima Medical University.
Department of Neural Regeneration, Fukushima Medical University.
Rinsho Shinkeigaku. 2018 Dec 21;58(12):756-760. doi: 10.5692/clinicalneurol.cn-001182. Epub 2018 Nov 29.
We report a 77-year-old man who suffered from Parkinson's disease for 12 years. Four years after the disease onset, he started to show excessive hobbyism of painting. His painting skills improved along with escalating enthusiasm. He even held a personal exhibition of his paintings. Dopaminergic treatment was increased as he developed wearing-off phenomenon. Six years after the disease onset, he developed dopamine dysregulation syndrome (DDS). In the same year, he underwent surgery for subthalamic deep brain stimulation. DDS did not improve and he did not lose enthusiasm for painting after surgery. Switching from ropinirole to rotigotine improved the DDS, but did not affect the excessive enthusiasm. At the age of 76, he started to have difficulty in completing the paintings. He had an uncontrollable urge to overlay paint strokes until the colors blurred and the paper was torn. In neuropsychological examinations, Mini-Mental State Examination score was above the cutoff, but Frontal Assessment Battery suggested motor perseveration and disinhibition. In summary, the patient's excessive enthusiasm for painting emerged in association with impulse control disorder (ICD) by dopamine agonist therapy, and subsequent change in his painting style appeared to be related with motor perseveration and/or further escalation of ICD.
我们报告一名77岁男性，患有帕金森病12年。发病4年后，他开始表现出对绘画的过度痴迷。随着热情不断高涨，他的绘画技巧有所提高。他甚至举办了个人画展。随着他出现剂末现象，多巴胺能治疗剂量增加。发病6年后，他患上了多巴胺调节障碍综合征（DDS）。同年，他接受了丘脑底核深部脑刺激手术。术后DDS并未改善，他对绘画的热情也未减退。从罗匹尼罗换用罗替戈汀改善了DDS，但并未影响其过度热情。76岁时，他开始难以完成画作。他有一种无法控制的冲动，不断叠加笔触，直到颜色模糊、纸张破损。在神经心理学检查中，简易精神状态检查表评分高于临界值，但额叶评估量表显示存在动作持续和去抑制现象。总之，患者对绘画的过度热情与多巴胺激动剂治疗引发的冲动控制障碍（ICD）有关，随后其绘画风格的改变似乎与动作持续和/或ICD的进一步加重有关。
