Amstutz Deborah, Petermann Katrin, Sousa Mario, Debove Ines, Maradan-Gachet Marie Elise, Bruhin Lena C, Magalhães Andreia D, Tinkhauser Gerd, Diamantaras Andreas, Waskönig Julia, Lachenmayer Lenard Martin, Pollo Claudio, Cazzoli Dario, Nef Tobias, Husain Masud, Krack Paul
Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
Mov Disord Clin Pract. 2025 Apr;12(4):484-496. doi: 10.1002/mdc3.14318. Epub 2025 Jan 3.
Impulse control disorders (ICD) are common side effects of dopaminergic treatment in Parkinson's disease (PD). Whereas some studies show a reduction in ICD after subthalamic nucleus deep brain stimulation (STN-DBS), others report worsening of ICD or impulsivity.
The aim was to study ICD in the context of STN-DBS using an objective measure of decision-making.
Ten PD patients performed an effort-based decision-making task alongside neuropsychiatric and cognitive evaluation before and 4 months after STN-DBS. Further, 33 PD patients underwent the same experimental procedures just once after an average 40 months of chronic STN-DBS. Participants were examined preoperatively in the medication on state and postoperatively in the medication on/stimulation ON state. Mixed linear models were used to assess the impact of ICD and STN-DBS on acceptance rate and decision time in the task while controlling for motor symptom burden, cognitive measures, and dopaminergic medication.
Results revealed an increased willingness to exert high levels of effort in return for reward in patients with ICD, but acceptance rate was not modulated by chronic STN-DBS. Further, ICD, cognitive processing speed, and STN-DBS were all identified as positive predictors for faster decision speed. ICD scores showed a tendency to improve 4 months after STN-DBS, without an increase in apathy scores.
Chronic STN-DBS and ICD facilitate effort-based decision-making by speeding up judgment. Furthermore, ICD enhances the willingness to exert high levels of effort for reward. Both STN-DBS and dopaminergic medication impact motivated behavior and should be titrated carefully to balance neuropsychiatric symptoms.
冲动控制障碍（ICD）是帕金森病（PD）多巴胺能治疗常见的副作用。虽然一些研究显示丘脑底核深部脑刺激（STN-DBS）后ICD有所减轻，但其他研究报告ICD或冲动性加重。
旨在使用客观的决策测量方法研究STN-DBS背景下的ICD。
10例PD患者在STN-DBS术前和术后4个月进行基于努力的决策任务，同时进行神经精神和认知评估。此外，33例PD患者在平均40个月的慢性STN-DBS治疗后仅进行一次相同的实验程序。参与者在术前处于服药状态下接受检查，术后在服药/刺激开启状态下接受检查。使用混合线性模型评估ICD和STN-DBS对任务中接受率和决策时间的影响，同时控制运动症状负担、认知测量和多巴胺能药物。
结果显示，ICD患者为获得奖励而付出高水平努力的意愿增加，但接受率并未因慢性STN-DBS而受到调节。此外，ICD、认知处理速度和STN-DBS均被确定为决策速度加快的积极预测因素。ICD评分在STN-DBS术后4个月有改善趋势，且无冷漠评分增加。
慢性STN-DBS和ICD通过加快判断促进基于努力的决策。此外，ICD增强了为获得奖励而付出高水平努力的意愿。STN-DBS和多巴胺能药物均影响动机行为，应仔细调整剂量以平衡神经精神症状。
