Hernandez-Con Pilar, Lin Iris, Mamikonyan Eugenia, Deeb Wissam, Feldman Robert, Althouse Andrew, Barmore Ryan, Eisinger Robert S, Spindler Meredith, Okun Michael S, Weintraub Daniel, Chahine Lana M
Department of Pharmaceutical Outcomes and Policy University of Florida Gainesville Florida USA.
Department of Neurology University of Cincinnati Cincinnati Ohio USA.
Mov Disord Clin Pract. 2023 May 5;10(6):903-913. doi: 10.1002/mdc3.13738. eCollection 2023 Jun.
The effect of surgery on impulse control disorders (ICDs) remains unclear in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS).
To examine changes in ICD symptoms in PD patients undergoing DBS compared to a medication-only control group.
The study was a 2-center, 12-month, prospective, observational investigation of PD patients undergoing DBS and a control group matched on age, sex, dopamine agonist use, and baseline presence of ICDs. Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) and total levodopa equivalent daily dose (LEDD) were collected at baseline, 3, 6, and 12 months. Linear mixed-effects models assessed changes in mean QUIP-RS score (sum of buying, eating, gambling, and hypersexuality items).
The cohort included 54 participants (DBS = 26, controls = 28), mean (SD) age 64.3 (8.1) and PD duration 8.0 (5.2) years. Mean baseline QUIP-RS was higher in the DBS group at baseline (8.6 (10.7) vs. 5.3 (6.9), = 0.18). However, scores at 12 months follow-up were nearly identical (6.6 (7.3) vs. 6.0 (6.9) = 0.79). Predictors of change in QUIP-RS score were baseline QUIP-RS score (β = 0.483, < 0.001) and time-varying LEDD (β = 0.003, = 0.02). Eight patients (four in each group) developed de novo ICD symptoms during follow-up, although none met diagnostic criteria for an impulse control disorder.
ICD symptoms (including de novo symptoms) at 12 months follow-up were similar between PD patients undergoing DBS and patients treated with pharmacological therapy only. Monitoring for emergence of ICD symptoms is important in both surgically- and medication-only-treated PD patients.
在接受脑深部电刺激（DBS）的帕金森病（PD）患者中，手术对冲动控制障碍（ICD）的影响仍不明确。
比较接受DBS的PD患者与仅接受药物治疗的对照组中ICD症状的变化。
本研究是一项为期12个月的2中心前瞻性观察性调查，纳入接受DBS的PD患者以及在年龄、性别、多巴胺激动剂使用情况和ICD基线存在情况相匹配的对照组。在基线、3个月、6个月和12个月时收集帕金森病冲动控制障碍问卷-评分量表（QUIP-RS）和左旋多巴等效日总剂量（LEDD）。线性混合效应模型评估QUIP-RS平均评分（购买、进食、赌博和性欲亢进项目得分总和）的变化。
该队列包括54名参与者（DBS组=26名，对照组=28名），平均（标准差）年龄64.3（8.1）岁，PD病程8.0（5.2）年。DBS组基线时的平均QUIP-RS更高（8.6（10.7）对5.3（6.9），P=0.18）。然而，12个月随访时的评分几乎相同（6.6（7.3）对6.0（6.9），P=0.79）。QUIP-RS评分变化的预测因素为基线QUIP-RS评分（β=0.483，P<0.001）和随时间变化的LEDD（β=0.003，P=0.02）。8名患者（每组4名）在随访期间出现新发ICD症状，尽管无人符合冲动控制障碍的诊断标准。
接受DBS的PD患者与仅接受药物治疗的患者在12个月随访时的ICD症状（包括新发症状）相似。在接受手术治疗和仅接受药物治疗的PD患者中，监测ICD症状的出现都很重要。
