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Mao C, Zhang Y, Jiang J, Qin R, Ye Q, Zhu X, Wu J. Magnetic Resonance Imaging Biomarkers of Punding in Parkinson's Disease. Brain Sci 2023; 13:1423. [PMID: 37891792 PMCID: PMC10605844 DOI: 10.3390/brainsci13101423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Punding is a rare condition triggered by dopaminergic therapy in Parkinson's disease (PD), characterized by a complex, excessive, repetitive, and purposeless abnormal movement, and its pathogenesis remains unclear. We aimed to assess the brain structure alterations related to punding by using multipametric magnetic resonance imaging (MRI). Thirty-eight PD patients (19 with punding and 19 without punding) from the Parkinson's Progression Marker Initiative (PPMI) were included in this study. Cortical thickness was assessed with FreeSurfer, and the integrity of white matter fiber tracts and network topologies were analyzed by using FMRIB Software Library (FSL) and Pipeline for Analyzing braiN Diffusion imAges (PANDA). PD patients with punding showed a higher apathy score and more severe cortical atrophy in the left superior parietal, right inferior parietal, and right superior frontal gyrus, and worse integrity of the right cingulum cingulate tract compared to those without punding. On the other hand, no significant difference in structural network topologies was detected between the two groups. These data suggest that the specific area of destruction may be an MRI biomarker of punding risk, and these findings may have important implications for understanding the neural mechanisms of punding in PD.
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Affiliation(s)
- Chenglu Mao
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
| | - Yang Zhang
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
| | - Jialiu Jiang
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
| | - Ruomeng Qin
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
| | - Qing Ye
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
| | - Xiaolei Zhu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
| | - Jiayong Wu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; (C.M.); (Y.Z.); (J.J.); (R.Q.); (Q.Y.); (X.Z.)
- Department of Neurology, Nanjing Drum Tower Hospital, State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing 210008, China
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Rajalingam R, Fasano A. Punding in Parkinson's Disease: An Update. Mov Disord Clin Pract 2023; 10:1035-1047. [PMID: 37476310 PMCID: PMC10354600 DOI: 10.1002/mdc3.13748] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/16/2023] [Accepted: 04/02/2023] [Indexed: 07/22/2023] Open
Abstract
Background Punding is a stereotyped behavior characterized by an intense fascination with a complex, excessive, non-goal oriented, repetitive activity affecting individuals with Parkinson's disease (PD) on dopamine replacement therapy (DRT). Objectives In 2010, we published the first review focused on the pathophysiology of punding. This study aims to systematically review the literature of the past decade on punding in PD, particularly focusing on the clinical features, underlying pathophysiological mechanisms, and treatment. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched PubMed, Embase, and APA PsycInfo for articles published between July 1, 2010 and March 19, 2022. The search strategy included: (punding) AND (parkinson*). Results Of 256 studies identified, 29 were eligible for inclusion with 19 original research articles and 10 case reports. This review confirmed that predictors of punding in PD are higher doses of DRT, younger age, male sex, and increasing disease severity. We also found an association between punding and psychiatric and/or cognitive symptoms. Neuroimaging studies have showed that punding in PD is associated with a disconnection between midbrain, limbic and white matter tracts projecting to the frontal cortices and a breakdown of the connectivity among the crucial nodes of the reward circuit. Low-frequency repetitive transcranial magnetic stimulation on the dorsolateral prefrontal cortex has been shown to produce a transient beneficial effect in PD patients with punding. Conclusion In conclusion, although the clinical features of punding have been established, in the past 12 years, we gained a better understanding of the pathophysiological mechanisms of punding, mainly thanks to magnetic resonance imaging techniques.
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Affiliation(s)
- Rajasumi Rajalingam
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, UHNTorontoOntarioCanada
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, UHNTorontoOntarioCanada
- Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
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Nilles C, Amorelli G, Pringsheim TM, Martino D. "Unvoluntary" Movement Disorders: Distinguishing between Tics, Akathisia, Restless Legs, and Stereotypies. Semin Neurol 2023; 43:123-146. [PMID: 36854394 DOI: 10.1055/s-0043-1764164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Tics, stereotypies, akathisia, and restless legs fall at different places on the spectrum of discrete, unwanted and potentially disabling motor routines. Unlike tremor, chorea, myoclonus, or dystonia, this subgroup of abnormal movements is characterized by the subject's variable ability to inhibit or release undesired motor patterns on demand. Though it may be sometimes clinically challenging, it is crucial to distinguish these "unvoluntary" motor behaviors because secondary causes and management approaches differ substantially. To this end, physicians must consider the degree of repetitiveness of the movements, the existence of volitional control, and the association with sensory symptoms, or cognitive-ideational antecedent. This review aims to summarize the current existing knowledge on phenomenology, diagnosis, and treatment of tics, stereotypies, akathisia, and restless leg syndrome.
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Affiliation(s)
- Christelle Nilles
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gabriel Amorelli
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Spee BTM, Sladky R, Fingerhut J, Laciny A, Kraus C, Carls-Diamante S, Brücke C, Pelowski M, Treven M. Repeating patterns: Predictive processing suggests an aesthetic learning role of the basal ganglia in repetitive stereotyped behaviors. Front Psychol 2022; 13:930293. [PMID: 36160532 PMCID: PMC9497189 DOI: 10.3389/fpsyg.2022.930293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Recurrent, unvarying, and seemingly purposeless patterns of action and cognition are part of normal development, but also feature prominently in several neuropsychiatric conditions. Repetitive stereotyped behaviors (RSBs) can be viewed as exaggerated forms of learned habits and frequently correlate with alterations in motor, limbic, and associative basal ganglia circuits. However, it is still unclear how altered basal ganglia feedback signals actually relate to the phenomenological variability of RSBs. Why do behaviorally overlapping phenomena sometimes require different treatment approaches−for example, sensory shielding strategies versus exposure therapy for autism and obsessive-compulsive disorder, respectively? Certain clues may be found in recent models of basal ganglia function that extend well beyond action selection and motivational control, and have implications for sensorimotor integration, prediction, learning under uncertainty, as well as aesthetic learning. In this paper, we systematically compare three exemplary conditions with basal ganglia involvement, obsessive-compulsive disorder, Parkinson’s disease, and autism spectrum conditions, to gain a new understanding of RSBs. We integrate clinical observations and neuroanatomical and neurophysiological alterations with accounts employing the predictive processing framework. Based on this review, we suggest that basal ganglia feedback plays a central role in preconditioning cortical networks to anticipate self-generated, movement-related perception. In this way, basal ganglia feedback appears ideally situated to adjust the salience of sensory signals through precision weighting of (external) new sensory information, relative to the precision of (internal) predictions based on prior generated models. Accordingly, behavioral policies may preferentially rely on new data versus existing knowledge, in a spectrum spanning between novelty and stability. RSBs may then represent compensatory or reactive responses, respectively, at the opposite ends of this spectrum. This view places an important role of aesthetic learning on basal ganglia feedback, may account for observed changes in creativity and aesthetic experience in basal ganglia disorders, is empirically testable, and may inform creative art therapies in conditions characterized by stereotyped behaviors.
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Affiliation(s)
- Blanca T. M. Spee
- Vienna Cognitive Science Hub, University of Vienna, Vienna, Austria
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ronald Sladky
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Joerg Fingerhut
- Berlin School of Mind and Brain, Department of Philosophy, Humboldt-Universität zu Berlin, Berlin, Germany
- Faculty of Philosophy, Philosophy of Science and Religious Studies, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alice Laciny
- Konrad Lorenz Institute for Evolution and Cognition Research, Klosterneuburg, Austria
| | - Christoph Kraus
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Medical Neuroscience Cluster, Medical University of Vienna, Vienna, Austria
| | | | - Christof Brücke
- Medical Neuroscience Cluster, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Matthew Pelowski
- Vienna Cognitive Science Hub, University of Vienna, Vienna, Austria
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Marco Treven
- Konrad Lorenz Institute for Evolution and Cognition Research, Klosterneuburg, Austria
- Medical Neuroscience Cluster, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- *Correspondence: Marco Treven,
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Spontaneous alternation and stereotypical behaviour in deer mice: response to escitalopram and levetiracetam. Behav Pharmacol 2022; 33:282-290. [PMID: 35621170 DOI: 10.1097/fbp.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Obsessive-compulsive disorder is varyingly associated with cognitive impairment, that is, deficits in spatial working memory, although it seems unlikely that this is generalised across all domains of functioning. Further, it is unclear whether symptoms will respond to potentially novel, non-serotonergic drugs that have shown promise as so-called cognitive enhancers. Here, we studied low (Norm-N; n = 31) and compulsive-like high (Comp-H; n = 34) stereotypical deer mice (Peromyscus maniculatus bairdii) to establish (1) whether there is a relationship between stereotypical intensity and working memory ability as measured by spontaneous T-maze arm alternation and (2) if and how stereotypy and its association with changes in working memory, would respond to the known anti-compulsive agent, escitalopram, and the proposed cognitive enhancer, levetiracetam. After assessing the stereotypical and alternation behaviour of all animals at baseline, they were divided into three socially housed drug exposure groups, that is, water control (n = 11 per phenotype), escitalopram 50 mg/kg/d (n = 11 per phenotype) and levetiracetam 75 mg/kg/d (Norm-N: n = 9; Comp-H: n = 12). Drugs were administered for 28 days before stereotypy and alternation assessment were repeated. The present data indicate a weak negative relationship between stereotypical intensity and spontaneous alternation. While levetiracetam increased the time spent engaging in normal rodent activity by Comp-H, but not Norm-N animals, neither of the interventions affected the expression of Comp-H behaviour or the alternation behaviour of deer mice. In conclusion, this work points to some degree of cognitive involvement in Comp-H expression, which should be explored to further our understanding of compulsive-like stereotypy.
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Austgen G, Marsh L. Cognitive dysfunction and neuropsychiatric aspects of Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:59-90. [PMID: 35248207 DOI: 10.1016/bs.pbr.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Movement abnormalities, by definition, and cognitive changes, to varying extents, affect every patient with Parkinson's disease (PD) and are attributed to the underlying neurodegenerative disease. Various psychiatric disorders occur in most patients at some point over the course of PD, including in the prodromal phase. Even though psychiatric disturbances tend to aggravate motor and cognitive deficits, they are under-recognized and under-treated, and the role of the underlying neurological disease is often minimized. To provide an integrated approach to understanding neuropsychiatric aspects of PD, this chapter reviews how cognitive changes in PD relate to the common psychiatric disturbances in PD along with the prevalence, phenomenology, pathophysiology, and treatment of each.
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Affiliation(s)
- Gabriela Austgen
- Behavioral Neurology & Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Laura Marsh
- Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Professor, Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences and Department of Neurology, Baylor College of Medicine, Houston, TX, United States.
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Barbosa P, O'Sullivan SS, Joyce E, Lees AJ, Warner TT, Djamshidian A. Neuropsychiatric Features of Punding and Hobbyism in Parkinson's Disease. Mov Disord Clin Pract 2022; 9:82-86. [PMID: 35005069 PMCID: PMC8721828 DOI: 10.1002/mdc3.13363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/17/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the cognitive and neuropsychiatric profile associated with punding and hobbyism in Parkinson's disease (PD). OBJECTIVE To compare the clinical and neuropsychological features of PD patients with punding and hobbyism to PD controls. METHODS The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) was used as a screening tool, and a structured interview was used to diagnose punding/hobbyism. Clinical and neuropsychological assessment was conducted with validated questionnaires/scales. RESULTS Twenty-one patients with PD and punding (PD + pu) were compared to 26 with hobbyism (PD + h) and 25 PD controls. PD + pu patients showed higher levels of anxiety, non-motor symptoms and motor symptoms, and lower Frontal Assessment Battery scores. The PD + h group exhibited similar levels of anxiety and motor fluctuations to the PD + pu group. CONCLUSION PD + pu showed increased anxiety and frontal lobe dysfunction, similar to PD + h. Hobbyism could be a prodromal phase with increased risk of leading to punding.
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Affiliation(s)
- Pedro Barbosa
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and NeuroscienceInstitute of Neurology, University College LondonLondonUnited Kingdom
- The National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | | | - Eileen Joyce
- The National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
- Department of Clinical Movement Disorder and NeuroscienceInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Andrew J. Lees
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and NeuroscienceInstitute of Neurology, University College LondonLondonUnited Kingdom
| | - Thomas T. Warner
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and NeuroscienceInstitute of Neurology, University College LondonLondonUnited Kingdom
- The National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Atbin Djamshidian
- Reta Lila Weston Institute of Neurological Studies, Department of Clinical Movement Disorder and NeuroscienceInstitute of Neurology, University College LondonLondonUnited Kingdom
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
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Kwan C, Nuara SG, Gourdon JC, Huot P. Further characterisation of psychosis-like behaviours induced by L-DOPA in the MPTP-lesioned marmoset. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:1685-1692. [PMID: 33963876 DOI: 10.1007/s00210-021-02090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Abstract
Parkinson's disease (PD) psychosis afflicts over half of patients and poses a significant burden on quality of life. The aetiology of PD psychosis is multifactorial and likely arises from the complex interaction between dopamine replacement therapy and disease state. The 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-lesioned common marmoset is a validated model to predict the efficacy of therapeutic compounds for treatment-related complications, including PD psychosis. In this model, psychosis-like behaviours (PLBs) encompass stereotypies that are idiosyncratic in nature and reproducible with each L-3,4-dihydroxyphenylanaline (L-DOPA) administration. In the present study, we sought to expand upon the existing repertoire of PLBs through the characterisation of novel stereotypical behaviours that appear dependent on the environment. We then discuss our findings in the context of clinical reports on stereotypical behaviours termed "punding" in subjects with PD, which consists of stereotypical repetitive and senseless behaviours. The poor understanding of the pathophysiology governing punding and consequent lack of effective therapies stand to benefit from enhanced characterisation of these stereotypical behaviours in a validated pre-clinical model. We hope that further characterisation of PLBs in the MPTP-lesioned marmoset will be helpful in the evaluation of interventions that seek to alleviate PD psychosis symptoms.
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Affiliation(s)
- Cynthia Kwan
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), 3801 University St, Montreal, QC, H3A 2B4, Canada
| | - Stephen G Nuara
- Comparative Medicine & Animal Resource Centre, McGill University, Montreal, QC, Canada
| | - Jim C Gourdon
- Comparative Medicine & Animal Resource Centre, McGill University, Montreal, QC, Canada
| | - Philippe Huot
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), 3801 University St, Montreal, QC, H3A 2B4, Canada. .,Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada. .,Movement Disorder Clinic, Division of Neurology, Department of Neuroscience, McGill University Health Centre, Montreal, QC, Canada.
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Grassi G, Albani G, Terenzi F, Razzolini L, Ramat S. New pharmacological and neuromodulation approaches for impulsive-compulsive behaviors in Parkinson's disease. Neurol Sci 2021; 42:2673-2682. [PMID: 33852081 DOI: 10.1007/s10072-021-05237-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION A significant proportion of patients with Parkinson's disease (PD) display a set of impulsive-compulsive behaviors at some point during the course of illness. These behaviors range from the so-called behavioral addictions to dopamine dysregulation syndrome, punding and hoarding disorders. These behaviors have been consistently linked to the use of dopaminergic medications used to treat PD motor symptoms (dopamine agonists, levodopa, and other agents) and less consistently to neuromodulation techniques such as deep brain stimulation (DBS). Since there are still no approved treatments for these conditions, their pharmacological management is still a big challenge for clinicians. METHODS We conducted an extensive review of current pharmacological and neuromodulation literature for the management of impulsive-compulsive disorders in PD patients. RESULTS Pharmacological treatment approaches for impulsive-compulsive behaviors and DDS in PD patients include reduction of levodopa (LD), reduction/cessation of dopamine agonist (DA), and initiation of infusion therapies (apomorphine infusion and duodopa). Also, atomoxetine, a noradrenergic agent approved for the treatment of attention deficit hyperactivity disorder, showed some interesting preliminary results but there is still a lack of controlled longitudinal studies. Finally, while DBS effects on impulsive-compulsive disorders are still controversial, non-invasive techniques (such as transcranial magnetic stimulation and transcranial direct current stimulation) could have a potential positive effect but, again, there is still a lack of controlled trials. CONCLUSION Managing impulsivity and compulsivity in PD patients is still a non-evidence-based challenge for clinicians. Controlled trials on promising approaches such as atomoxetine and non-invasive neuromodulation techniques are needed.
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Affiliation(s)
- Giacomo Grassi
- Brain Center Firenze, Viale Belfiore 36, 5014, Florence, Italy.
| | | | | | - Lorenzo Razzolini
- Brain Center Firenze, Viale Belfiore 36, 5014, Florence, Italy.,University of Florence, Florence, Italy
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Marques A, Roquet D, Matar E, Taylor NL, Pereira B, O'Callaghan C, Lewis SJG. Limbic hypoconnectivity in idiopathic REM sleep behaviour disorder with impulse control disorders. J Neurol 2021; 268:3371-3380. [PMID: 33709218 DOI: 10.1007/s00415-021-10498-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Current neuroimaging research has revealed several brain alterations in idiopathic REM sleep behaviour disorder (iRBD) that mirror and precede those reported in PD. However, none have specifically addressed the presence of changes across the reward system, and their role in the emergence of impulse control disorders (ICDs). We aimed to compare the volumetric and functional connectivity characteristics of the reward system in relation to the psychobehavioral profile of patients with iRBD versus healthy controls and PD patients. METHODS Twenty patients with polysomnography confirmed iRBD along with 17 PD patients and 14 healthy controls (HC) underwent structural and functional resting-state brain MRI analysis. Participants completed the questionnaire for impulsive-compulsive disorders in PD (QUIP), the short UPPS-P impulsive behaviour scale, as well as neuropsychological testing of cognitive function. RESULTS A higher percentage of iRBD patients reported hypersexuality, compared to HC and PD (p = 0.008). Whole-brain and striatal voxel-based morphometry analyses showed no significant clusters of reduced grey matter volume between groups. However, iRBD compared to HC demonstrated functional hypoconnectivity between the limbic striatum and temporo-occipital regions. Furthermore, the presence of ICDs correlated with hypoconnectivity between the limbic striatum and clusters located in cuneus, lingual and fusiform gyrus. CONCLUSION Altered functional connectivity between the limbic striatum and posterior cortical regions was associated with increased hypersexuality in iRBD. It is possible that this change may ultimately predispose individuals to the emergence of ICDs when they receive dopaminergic medications, after transitioning to PD.
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Affiliation(s)
- Ana Marques
- Brain and Mind Center, School of Medical Sciences, University of Sydney, Forefront Parkinson's Disease Research Clinic, Sydney, Australia.
- Neurology department, Université Clermont-Auvergne, Clermont-Ferrand University Hospital, EA7280, Clermont-Ferrand, France.
| | - Daniel Roquet
- Frontiers, Brain and Mind Center, University of Sydney, Sydney, Australia
| | - Elie Matar
- Brain and Mind Center, School of Medical Sciences, University of Sydney, Forefront Parkinson's Disease Research Clinic, Sydney, Australia
| | - Natasha Louise Taylor
- Brain and Mind Center, School of Medical Sciences, University of Sydney, Forefront Parkinson's Disease Research Clinic, Sydney, Australia
| | - Bruno Pereira
- Biostatistics Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Claire O'Callaghan
- Brain and Mind Center, School of Medical Sciences, University of Sydney, Forefront Parkinson's Disease Research Clinic, Sydney, Australia
| | - Simon J G Lewis
- Brain and Mind Center, School of Medical Sciences, University of Sydney, Forefront Parkinson's Disease Research Clinic, Sydney, Australia
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Hinkle JT, Perepezko K, Mills KA, Pontone GM. Attentional dysfunction and the punding spectrum in Parkinson's disease. Parkinsonism Relat Disord 2021; 84:23-28. [PMID: 33545553 PMCID: PMC7980283 DOI: 10.1016/j.parkreldis.2021.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/05/2020] [Accepted: 01/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Punding is a complication of Parkinson's disease (PD) treatment and stimulant abuse that features excessive preoccupation with repetitive and/or aimless behaviors. We hypothesized that cognitive impairment and functional limitations influence how punding behaviors manifest in PD. METHODS We extracted data on punding, hobbyism, and cognition from the Parkinson's Progression Marker Initiative (PPMI). Punding and hobbyism were measured with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) scale. We determined how cognition predicted punding and hobbyism behaviors-adjusting for levodopa dose, Hoehn & Yahr stage, disease duration, and age-using generalized estimating equation (GEE) logistic regression. Activities of daily living (ADL) and motor impairment were measured with the MDS-UPDRS scale. RESULTS In GEE logistic regression models, punding was selectively associated with lower scores on the Letter Number Sequencing test (LNS), the primary attention test in PPMI (Odds ratio: 0.87 (95% CI: 0.79-0.96); p = 0.022). This was corroborated by a subscale-analysis of Montreal Cognitive Assessment (MoCA) scores, as only the attention subscale was significantly associated with punding (OR: 0.59 (0.45-0.77); p < 0.001). Baseline impairment in LNS (Hazard ratio: 2.52 (1.22-5.20); p = 0.012) and MoCA attention (HR: 2.68 (1.32-5.42); p = 0.006) predicted earlier punding in Cox regression. In turn, ADL dysfunction predicted punding (OR: 1.55 (1.20-2.00); p < 0.001), but not hobbyism. CONCLUSION Attentional dysfunction is a domain-specific cognitive biomarker of punding risk in PD. Further, attentional capacity and functional impairment may determine the complexity of perseverative behaviors on the continuum from rudimentary punding to semi-purposeful hobbyism.
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Affiliation(s)
- Jared T Hinkle
- Medical Scientist Training Program, USA; Solomon H. Snyder Department of Neuroscience, USA.
| | - Kate Perepezko
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA; Department of Psychiatry and Behavioral Sciences, USA
| | - Kelly A Mills
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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12
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Pouchon A, Dondé C, Polosan M. Punding Behavior as a Red Flag for Dementia in a Patient With Depression: Case Report. Front Psychiatry 2021; 12:637861. [PMID: 33912083 PMCID: PMC8071987 DOI: 10.3389/fpsyt.2021.637861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/11/2021] [Indexed: 11/21/2022] Open
Abstract
Punding is defined as a stereotypic, complex, repetitive, and non-goal-oriented activity. This behavior has been observed in Parkinson's disease and chronic amphetamine users. However, in general, punding behavior is largely under-diagnosed. Here, we describe a rare case of a 53-year-old woman showing punding behavior during major depressive disorder with atypical clinical features suggestive of a frontal syndrome. Neuropsychological evaluations mainly reported deficits in executive functioning. Brain MRI and lumbar puncture were normal. Brain perfusion SPECT showed hypoperfusion predominating in the right frontal and parietooccipital lobes, and a slight hypoperfusion in subthalamic nucleus including the posterior area of right striatum. We diagnosed this case as a frontotemporal dementia. Punding behavior could be a red flag for dementia in patients with major depressive disorder.
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Affiliation(s)
- Arnaud Pouchon
- Univ. Grenoble Alpes, Inserm U1216 Grenoble Institute of Neurosciences, Psychiatry Department CHU Grenoble Alpes, Grenoble, France
| | - Clément Dondé
- Univ. Grenoble Alpes, Inserm U1216 Grenoble Institute of Neurosciences, Psychiatry Department CHU Grenoble Alpes, Grenoble, France
| | - Mircea Polosan
- Univ. Grenoble Alpes, Inserm U1216 Grenoble Institute of Neurosciences, Psychiatry Department CHU Grenoble Alpes, Grenoble, France
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13
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Neuropsychiatric aspects of Parkinson disease psychopharmacology: Insights from circuit dynamics. HANDBOOK OF CLINICAL NEUROLOGY 2020; 165:83-121. [PMID: 31727232 DOI: 10.1016/b978-0-444-64012-3.00007-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Parkinson disease (PD) is a neurodegenerative disorder with a complex pathophysiology characterized by the progressive loss of dopaminergic neurons within the substantia nigra. Persons with PD experience several motoric and neuropsychiatric symptoms. Neuropsychiatric features of PD include depression, anxiety, psychosis, impulse control disorders, and apathy. In this chapter, we will utilize the National Institutes of Mental Health Research Domain Criteria (RDoC) to frame and integrate observations from two prevailing disease constructions: neurotransmitter anomalies and circuit physiology. When there is available evidence, we posit how unified translational observations may have clinical relevance and postulate importance outside of PD. Finally, we review the limited evidence available for pharmacologic management of these symptoms.
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Dujardin K, Sgambato V. Neuropsychiatric Disorders in Parkinson's Disease: What Do We Know About the Role of Dopaminergic and Non-dopaminergic Systems? Front Neurosci 2020; 14:25. [PMID: 32063833 PMCID: PMC7000525 DOI: 10.3389/fnins.2020.00025] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/10/2020] [Indexed: 12/13/2022] Open
Abstract
Besides the hallmark motor symptoms (rest tremor, hypokinesia, rigidity, and postural instability), patients with Parkinson’s disease (PD) have non-motor symptoms, namely neuropsychiatric disorders. They are frequent and may influence the other symptoms of the disease. They have also a negative impact on the quality of life of patients and their caregivers. In this article, we will describe the clinical manifestations of the main PD-related behavioral disorders (depression, anxiety disorders, apathy, psychosis, and impulse control disorders). We will also provide an overview of the clinical and preclinical literature regarding the underlying mechanisms with a focus on the role of the dopaminergic and non-dopaminergic systems.
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Affiliation(s)
- Kathy Dujardin
- Inserm U1171 Degenerative and Vascular Cognitive Disorders, Lille University Medical Center, Lille, France
| | - Véronique Sgambato
- CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, Lyon University, Bron, France
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15
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Aoki R, Shiraishi M, Mikami K, Kamo T. Deterioration of postural deformity in Parkinson's disease patients with punding and hobbyism. J Clin Neurosci 2019; 69:179-183. [PMID: 31400998 DOI: 10.1016/j.jocn.2019.07.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/29/2019] [Indexed: 11/25/2022]
Abstract
This study aimed to examine whether worsening of postural deformities is seen in Parkinson's disease (PD) patients who exhibit the behavioral disorders punding or hobbyism (P-H), which involve maintaining the same poor posture. The subjects were 80 patients with PD (aged 73.1 ± 8.8 years; duration of disease, 6.4 ± 5.5 years). Using the Japanese-language version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (J-QUIP), a group with P-H alone (P-H only group) and a group without impulsive-compulsive behaviors (non-ICB group) were compared with respect to the angles of forward and lateral trunk flexion while standing at rest. The group with ICBs (ICB group) identified by the J-QUIP consisted of 36 patients (45.0%). Of these, 25 (31.3%) were in the P-H only group. The non-ICB group, who were negative on all items of the J-QUIP, consisted of 44 patients (55.0%). Significantly higher values were seen in the P-H only group compared with non-ICB group for the angle of forward flexion of the trunk (FFT angle, p = 0.04), Unified Parkinson's Disease Rating Scale (UPDRS) part II score (p = 0.002), and UPDRS total score (p = 0.007). The FFT angle was increased and activities of daily living decreased in PD patients with P-H.
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Affiliation(s)
- Ryoma Aoki
- Department of Rehabilitation, Noborito Neurology Clinic, 434 Nobotitoshinmachi, Tama-ku, Kawasaki City, Kanagawa, Japan.
| | - Makoto Shiraishi
- Department of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, Japan.
| | - Kyohei Mikami
- Department of Rehabilitation, Noborito Neurology Clinic, 434 Nobotitoshinmachi, Tama-ku, Kawasaki City, Kanagawa, Japan
| | - Tsutomu Kamo
- Department of Neurology, Noborito Neurology Clinic, 434 Nobotitoshinmachi, Tama-ku, Kawasaki City, Kanagawa, Japan.
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16
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Shafer RL, Solomon EM, Newell KM, Lewis MH, Bodfish JW. Visual feedback during motor performance is associated with increased complexity and adaptability of motor and neural output. Behav Brain Res 2019; 376:112214. [PMID: 31494179 DOI: 10.1016/j.bbr.2019.112214] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 11/19/2022]
Abstract
Complex motor behavior is believed to be dependent on sensorimotor integration - the neural process of using sensory input to plan, guide, and correct movements. Previous studies have shown that the complexity of motor output is low when sensory feedback is withheld during precision motor tasks. However, much of this research has focused on motor behavior rather than neural processing, and therefore, has not specifically assessed the role of sensorimotor neural functioning in the execution of complex motor behavior. The present study uses a stimulus-tracking task with simultaneous electroencephalography (EEG) recording to assess the effect of visual feedback on motor performance, motor complexity, and sensorimotor neural processing in healthy adults. The complexity of the EEG signal was analyzed to capture the information content in frequency bands (alpha and beta) and scalp regions (central, parietal, and occipital) that are associated with sensorimotor processing. Consistent with previous literature, motor performance and its complexity were higher when visual feedback was provided relative to when it was withheld. The complexity of the neural signal was also higher when visual feedback was provided. This was most robust at frequency bands (alpha and beta) and scalp regions (parietal and occipital) associated with sensorimotor processing. The findings show that visual feedback increases the information available to the brain when generating complex, adaptive motor output.
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Affiliation(s)
- Robin L Shafer
- Vanderbilt Brain Institute, Vanderbilt University, 6133 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, USA.
| | - Eli M Solomon
- Neuroscience and Behavior Program, Wesleyan University Rm 257 Hall-Atwater, Wesleyan University, Middletown, CT, 06459, USA.
| | - Karl M Newell
- Department of Kinesiology, University of Georgia, G3 Aderhold Hall, 110 Carlton Street, Athens, GA, 30602, USA.
| | - Mark H Lewis
- Department of Psychiatry, University of Florida College of Medicine, PO Box 100256, L4-100 McKnight Brain Institute, 1149 Newell Drive, Gainesville, FL, 32611, USA.
| | - James W Bodfish
- Vanderbilt Brain Institute, Vanderbilt University, 6133 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, USA; Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 8310 Medical Center East, 1215 21st Avenue South, Nashville, TN, 37232, USA.
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17
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Izzo VA, Donati MA, Torre E, Ramat S, Primi C. Impulse control disorders in Parkinson's disease versus in healthy controls: A different predictive model. J Neuropsychol 2019; 14:318-332. [PMID: 31423741 DOI: 10.1111/jnp.12193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 07/22/2019] [Indexed: 01/26/2023]
Abstract
Impulse control disorders (ICDs), including compulsive gambling, buying, sexual behaviour and eating, are not only a severe disorder that can affect the general, non-clinical population, but also a serious, increasingly recognized psychiatric complication in Parkinson's disease (PD). Previous research detected some risk factors for their occurrence in PD patients and in the general population, including impulsivity. However, impulsivity is a multidimensional construct that comprises several aspects, including reflection impulsivity and delay discounting. The present work assessed different facets of impulsivity in both PD patients and in the healthy controls (HCs) to examine whether they scored differently, and if the occurrence of ICDs in PD patients and in the HCs was predicted by different aspects of impulsivity. The results showed that ICDs in PD patients were predicted by a strong preference for immediate rewards, whereas ICDs in the HCs were predicted by a deficient reflective ability. The present findings may help clinicians in the early identification of PD patients who could develop ICDs by simply assessing their impulsivity in terms of delay discounting. Furthermore, this work contributed to identify another risk factor for ICDs in the non-clinical population.
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Affiliation(s)
- Viola Angela Izzo
- NEUROFARBA Department - Section of Psychology, University of Florence, Italy
| | - Maria Anna Donati
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | - Elena Torre
- Azienda Usl 4 di Prato - U. O. Neurologia, Prato, Italy
| | | | - Caterina Primi
- NEUROFARBA Department - Section of Psychology, University of Florence, Italy
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18
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Impulse control disorders in Parkinson's disease: A systematic review on the psychometric properties of the existing measures. PLoS One 2019; 14:e0217700. [PMID: 31163065 PMCID: PMC6548365 DOI: 10.1371/journal.pone.0217700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/16/2019] [Indexed: 11/19/2022] Open
Abstract
Background A significant percentage of patients suffering from Parkinson’s Disease (PD) experience Impulse Control Disorders (ICDs), contributing to reduced quality of life. As they can be managed by reducing the dopamine dosage, the detection of their presence is crucial for PD treatment plan. Nevertheless, they tend to be under-recognized in clinical practice, since routine screening is not common–despite existing instruments that may support clinicians. This work presents a systematic review on the psychometric properties of instruments measuring ICDs in PD, to test whether clinicians dispose of valid tools that may help them in clinical assessment. Method A systematic literature search in three databases (EMBASE, MEDLINE, and PsycINFO) was conducted. Quality of the instruments’ psychometric properties was evaluated with Terwee et al.’s criteria, and methodological quality of the studies was evaluated with the COSMIN Checklist. Results Ten studies examining seven instruments were selected. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP) and the Ardouin Scale of Behavior in Parkinson’s Disease (ASBPD) resulted to be the best from a psychometric point of view. Conclusions Though the gold standard for diagnosis remains a detailed diagnostic interview, this review will encourage clinicians to use validated tools to accurately assess ICDs.
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19
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Eisinger RS, Ramirez-Zamora A, Carbunaru S, Ptak B, Peng-Chen Z, Okun MS, Gunduz A. Medications, Deep Brain Stimulation, and Other Factors Influencing Impulse Control Disorders in Parkinson's Disease. Front Neurol 2019; 10:86. [PMID: 30863353 PMCID: PMC6399407 DOI: 10.3389/fneur.2019.00086] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
Impulse control disorders (ICDs) in Parkinson's disease (PD) have a high cumulative incidence and negatively impact quality of life. ICDs are influenced by a complex interaction of multiple factors. Although it is now well-recognized that dopaminergic treatments and especially dopamine agonists underpin many ICDs, medications alone are not the sole cause. Susceptibility to ICD is increased in the setting of PD. While causality can be challenging to ascertain, a wide range of modifiable and non-modifiable risk factors have been linked to ICDs. Common characteristics of PD patients with ICDs have been consistently identified across many studies; for example, males with an early age of PD onset and dopamine agonist use have a higher risk of ICD. However, not all cases of ICDs in PD can be directly attributable to dopamine, and studies have concluded that additional factors such as genetics, smoking, and/or depression may be more predictive. Beyond dopamine, other ICD associations have been described but remain difficult to explain, including deep brain stimulation surgery, especially in the setting of a reduction in dopaminergic medication use. In this review, we will summarize the demographic, genetic, behavioral, and clinical contributions potentially influencing ICD onset in PD. These associations may inspire future preventative or therapeutic strategies.
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Affiliation(s)
- Robert S. Eisinger
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Hospital Padre Hurtado, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Samuel Carbunaru
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Brandon Ptak
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Zhongxing Peng-Chen
- Hospital Padre Hurtado, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Michael S. Okun
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
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20
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Béreau M, Fleury V, Bouthour W, Castrioto A, Lhommée E, Krack P. Hyperdopaminergic behavioral spectrum in Parkinson's disease: A review. Rev Neurol (Paris) 2018; 174:653-663. [DOI: 10.1016/j.neurol.2018.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 02/08/2023]
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21
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Vargas AP, Cardoso FEC. Impulse control and related disorders in Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:399-410. [PMID: 29972423 DOI: 10.1590/0004-282x20180052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/17/2018] [Indexed: 12/29/2022]
Abstract
Neuropsychiatric disorders are common among patients with Parkinson's disease and may appear in any stage of the disease. However, these disorders often go undiagnosed and receive insufficient treatment. Observations in recent years have revealed that dopamine replacement therapy may lead to the development or worsening of conditions, such as gambling disorder, compulsive sexual behavior, compulsive buying and binge eating, in addition to punding and dopamine dysregulation syndrome. The pathophysiology of these disorders seems to be related to abnormal dopaminergic stimulation of the basal regions of the basal ganglia, especially via nigro-mesolimbic pathways. The aim of the present study was to perform a literature review on impulsivity, impulse control disorders and related conditions among patients with Parkinson's disease, with emphasis on their epidemiology, clinical characteristics and treatment.
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Affiliation(s)
- Antonio Pedro Vargas
- Rede SARAH de Hospitais de Reabilitação, Departamento de Neurologia, Belo Horizonte MG, Brasil
| | - Francisco Eduardo Costa Cardoso
- Universidade Federal de Minas Gerais, Unidade de Distúrbios do Movimento, Departamento de Clínica Médica, Serviço de Neurologia, Belo Horizonte MG, Brasil
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22
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Lotia M, York MK, Strutt AM, Jankovic J. Leg stereotypy syndrome: phenomenology and prevalence. J Neurol Neurosurg Psychiatry 2018; 89:692-695. [PMID: 29332008 DOI: 10.1136/jnnp-2017-317057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/30/2017] [Accepted: 12/20/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To describe the phenomenology and prevalence of leg stereotypy syndrome (LSS), characterised chiefly by repetitive, rhythmical, stereotypic leg movement, especially when sitting. METHODS We sought to characterise LSS in two groups of subjects: (1) general population (GP) group, defined as individuals accompanying patients during their visits to Baylor College of Medicine Parkinson's Disease Center and Movement Disorders Clinic who are not genetically related to the patients; and (2) movement disorders (MD) group, composed of consecutive patients with diagnoses of restless legs syndrome, Parkinson's disease, Tourette syndrome and tardive dyskinesia. RESULTS There were 92 participants enrolled in this study; 7% of 57 individuals in the GP group and 17% of those in the MD group met the diagnostic criteria for LSS. The mean age of individuals with LSS was 44.5 (±11.9) years and mean age at onset of LSS was 17.5 (±5.7) years. In half of the individuals, the 'shaking' involved predominantly one leg. All had a positive family history of similar disorder and none had diurnal variation. The seven-item Leg Stereotypy Syndrome Questionnaire was developed as a screening tool to aid in differentiating LSS from other movement disorders. CONCLUSIONS LSS is a common condition, occurring in up to 7% of otherwise healthy individuals, and it is even more common in patients with hyperkinetic movement disorders. Although it phenomenologically may overlap with other stereotypic disorders, we argue that it is a distinct, familial, neurological syndrome.
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Affiliation(s)
- Mitesh Lotia
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
| | - Michele K York
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
| | - Adriana M Strutt
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
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23
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Zhu W, Luo X, Adnan A, Yu P, Zhang S, Huo Z, Xu Q, Pang H. Association analysis of NUCKS1 and INPP5K polymorphism with Parkinson’s disease. Genes Genet Syst 2018; 93:59-64. [DOI: 10.1266/ggs.17-00038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Wenqing Zhu
- School of Forensic Medicine, China Medical University
| | - Xiaoguang Luo
- Department of Neurology, First Affiliated Hospital of China Medical University
| | - Atif Adnan
- School of Forensic Medicine, China Medical University
| | - Peifu Yu
- School of Forensic Medicine, China Medical University
| | - Siyi Zhang
- School of Forensic Medicine, China Medical University
| | - Zhixin Huo
- School of Forensic Medicine, China Medical University
| | - Qin Xu
- School of Forensic Medicine, China Medical University
| | - Hao Pang
- School of Forensic Medicine, China Medical University
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24
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Kim R, Jeon B. Nonmotor Effects of Conventional and Transdermal Dopaminergic Therapies in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:989-1018. [PMID: 28805592 DOI: 10.1016/bs.irn.2017.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Nonmotor symptoms (NMS) are an integral component of Parkinson's disease (PD). Because the burden and range of NMS are key determinants of quality of life for patients and caregivers, their management is a crucial issue in clinical practice. Although a range of NMS have a dopaminergic pathophysiological basis, this fact is underrecognized, and thus, they are often regarded as dopamine unresponsive symptoms. However, substantial evidence indicates that many NMS respond to oral and transdermal dopaminergic therapies. In contrast, certain NMS are exacerbated or even precipitated by dopaminergic drugs and these unwanted effects may be seriously dangerous. Therefore, a dopaminergic strategy for NMS should be based on a consideration of the benefits vs the risks in individual patients with PD.
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Affiliation(s)
- Ryul Kim
- Seoul National University, College of Medicine, Seoul, South Korea
| | - Beomseok Jeon
- Seoul National University, College of Medicine, Seoul, South Korea.
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25
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Maltête D. Adult-onset stereotypical motor behaviors. Rev Neurol (Paris) 2016; 172:477-482. [PMID: 27498241 DOI: 10.1016/j.neurol.2016.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/18/2016] [Accepted: 07/07/2016] [Indexed: 11/16/2022]
Abstract
Stereotypies have been defined as non-goal-directed movement patterns repeated continuously for a period of time in the same form and on multiple occasions, and which are typically distractible. Stereotypical motor behaviors are a common clinical feature of a variety of neurological conditions that affect cortical and subcortical functions, including autism, tardive dyskinesia, excessive dopaminergic treatment of Parkinson's disease and frontotemporal dementia. The main differential diagnosis of stereotypies includes tic disorders, motor mannerisms, compulsion and habit. The pathophysiology of stereotypies may involve the corticostriatal pathways, especially the orbitofrontal and anterior cingulated cortices. Because antipsychotics have long been used to manage stereotypical behaviours in mental retardation, stereotypies that present in isolation tend not to warrant pharmacological intervention, as the benefit-to-risk ratio is not great enough.
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Affiliation(s)
- D Maltête
- Department of Neurology, Rouen University Hospital, University of Rouen, 1, rue de Germont, 76031 cedex Rouen, France; Inserm U 1073, 22, boulevard Gambetta, 76183 Rouen cedex, France.
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26
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Guedes BF, Gonçalves MR, Cury RG. Psychosis and concurrent impulse control disorder in Parkinson's disease: A review based on a case report. Dement Neuropsychol 2016; 10:148-151. [PMID: 29213446 PMCID: PMC5642406 DOI: 10.1590/s1980-5764-2016dn1002011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Psychosis, impulse control disorders (e.g., pathological gambling and hypersexuality) and repetitive behaviors such as punding are known psychiatric complications of Parkinson's disease (PD). Impulsive, compulsive and repetitive behaviors are strongly associated with dopamine-replacement therapy. We present the case of a 58-year-old man with PD and a myriad of psychiatric symptoms. Concurrent psychosis, punding and pathological gambling developed more than six years after the introduction of pramipexole and ceased shortly after the addition of quetiapine and discontinuation of pramipexole. This report emphasizes the importance of monitoring for a wide array of psychiatric symptoms in patients on dopamine replacement therapy.
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27
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Pettorruso M, Fasano A, De Risio L, Ricciardi L, Di Nicola M, Martinotti G, Janiri L, Bentivoglio AR. Punding in non-demented Parkinson's disease patients: Relationship with psychiatric and addiction spectrum comorbidity. J Neurol Sci 2016; 362:344-7. [DOI: 10.1016/j.jns.2016.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 12/06/2015] [Accepted: 02/07/2016] [Indexed: 12/28/2022]
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28
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The prevalence and clinical characteristics of hypersexuality in patients with Parkinson's disease following dopaminergic therapy: A systematic literature review. Parkinsonism Relat Disord 2016; 25:10-6. [PMID: 26923525 DOI: 10.1016/j.parkreldis.2016.02.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 02/14/2016] [Accepted: 02/16/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION A range of impulse control disorders have been identified as possible behavioural effects of brain dopamine replacement therapy (DRT) in patients with Parkinson's disease (PD). Among the behavioural problems associated with dysregulation of dopaminergic pathways underlying reward processing, hypersexuality carries significant social and legal repercussions, in addition to embarrassment for the patient with PD and his/her family. The present article evaluates the prevalence and characteristics of hypersexuality in the context of PD, focusing on the best available evidence. METHODS We conducted a systematic literature review according to the Prisma guidelines on large-scale epidemiological studies (n > 250) assessing hypersexuality in patients with PD treated with DRT. RESULTS Our systematic literature review identified 10 relevant studies characterised by medium-to-large sample sizes (n = 268-3090). Average lifetime prevalence of hypersexuality in patients with PD on DRT was found to be 2.7% (7.4% in patients on dopamine agonists). In general, hypersexuality was associated with male gender and higher doses of dopamine agonists. Other clinically relevant associations included younger age, earlier PD onset and history of behavioural symptoms prior to dopamine agonist use. CONCLUSION Hypersexuality is not rare in patients with PD treated with DRT, particularly in those on dopamine agonists. These findings indicate that PD specialists should regularly screen and monitor for hypersexuality, paying particular attention to younger male patients, with an early PD onset and previous history of behavioural problems.
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29
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Yoo HS, Yun HJ, Chung SJ, Sunwoo MK, Lee JM, Sohn YH, Lee PH. Patterns of Neuropsychological Profile and Cortical Thinning in Parkinson's Disease with Punding. PLoS One 2015. [PMID: 26218765 PMCID: PMC4517876 DOI: 10.1371/journal.pone.0134468] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Punding, one of dopamine replacement treatment related complications, refers to aimless and stereotyped behaviors. To identify possible neural correlates of punding behavior in patients with Parkinson's disease (PD), we investigated the patterns of cognitive profiles and cortical thinning. METHODS Of the 186 subjects with PD screened during the study period, we prospectively enrolled 10 PD patients with punding and 43 without punding on the basis of a structured interview. We performed comprehensive neuropsychological tests and voxel-based and regions-of-interest (ROIs)-based cortical thickness analysis between PD patients with and without punding. RESULTS The prevalence of punding in patients with PD was 5.4%. Punding behaviors were closely related to previous occupations or hobbies and showed a temporal relationship to changes of levodopa-equivalent dose (LED). Significant predisposing factors were a long duration of PD and intake of medications of PD, high total daily LED, dyskinesia, and impulse control disorder. Punding severity was correlated with LED (p = 0.029). The neurocognitive assessment revealed that PD patients with punding showed more severe cognitive deficits in the color Stroop task than did those without punding (p = 0.022). Voxel-based analysis showed that PD-punders had significant cortical thinning in the dorsolateral prefrontal area relative to controls. Additionally, ROI-based analysis revealed that cortical thinning in PD-punders relative to PD-nonpunders was localized in the prefrontal cortices, extending into orbitofrontal area. CONCLUSIONS We demonstrated that PD patients with punding performed poorly on cognitive tasks in frontal executive functions and showed severe cortical thinning in the dorsolateral prefrontal and orbitofrontal areas. These findings suggest that prefrontal modulation may be an essential component in the development of punding behavior in patients with PD.
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Affiliation(s)
- Han Soo Yoo
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyuk Jin Yun
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Mun Kyung Sunwoo
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Young Ho Sohn
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- Severance Biomedical Science Institute, Seoul, South Korea
- * E-mail:
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Rieu I, Martinez-Martin P, Pereira B, De Chazeron I, Verhagen Metman L, Jahanshahi M, Ardouin C, Chéreau I, Brefel-Courbon C, Ory-Magne F, Klinger H, Peyrol F, Schupbach M, Dujardin K, Tison F, Houeto JL, Krack P, Durif F. International validation of a behavioral scale in Parkinson's disease without dementia. Mov Disord 2015; 30:705-13. [PMID: 25809278 DOI: 10.1002/mds.26223] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 12/08/2014] [Accepted: 12/14/2014] [Indexed: 12/16/2022] Open
Abstract
The "Ardouin Scale of Behavior in Parkinson's Disease" is a new instrument specifically designed for assessing mood and behavior with a view to quantifying changes related to Parkinson's disease, to dopaminergic medication, and to non-motor fluctuations. This study was aimed at analyzing the psychometric attributes of this scale in patients with Parkinson's disease without dementia. In addition to this scale, the following measures were applied: the Unified Parkinson's Disease Rating Scale, the Montgomery and Asberg Depression Rating Scale, the Lille Apathy Rating Scale, the Bech and Rafaelsen Mania Scale, the Positive and Negative Syndrome Scale, the MacElroy Criteria, the Patrick Carnes criteria, the Hospital Anxiety and Depression Scale, and the Mini-International Neuropsychiatric Interview. Patients (n=260) were recruited at 13 centers across four countries (France, Spain, United Kingdom, and United States). Cronbach's alpha coefficient for domains ranged from 0.69 to 0.78. Regarding test-retest reliability, the kappa coefficient for items was higher than 0.4. For inter-rater reliability, the kappa values were 0.29 to 0.81. Furthermore, most of the items from the Ardouin Scale of Behavior in Parkinson's Disease correlated with the corresponding items of the other scales, depressed mood with the Montgomery and Asberg Depression Rating Scale (ρ=0.82); anxiety with the Hospital Anxiety and Depression Scale-anxiety (ρ=0.56); apathy with the Lille Apathy Rating Scale (ρ=0.60). The Ardouin Scale of Behavior in Parkinson's disease is an acceptable, reproducible, valid, and precise assessment for evaluating changes in behavior in patients with Parkinson's disease without dementia.
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Affiliation(s)
- Isabelle Rieu
- CHU Clermont-Ferrand, Neurology Department; CHU Gabriel Montpied, Clermont-Ferrand, France; Université Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France
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Larson ER. Neuropsychological findings in a case of punding before and after cessation of pramipexole. Clin Neuropsychol 2015; 29:166-78. [PMID: 25658417 DOI: 10.1080/13854046.2015.1005674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Clinical neuropsychologists are well trained to recognize neurological and psychiatric conditions that impact behavior, but tend to have less familiarity with iatrogenic consequences of various pharmacological treatments. One such consequence is the development of an impulse control disorder (ICD), which can result from treatment with dopamine agonists. Knowledge of ICDs is important because they can mimic obsessive-compulsive disorder, mania, or the behavioral variant of frontotemporal dementia. The current case examines a patient who developed punding, which is a type of ICD characterized by repetitive behavior, as a result of treatment with pramipexole. Neuropsychological testing was conducted before and after cessation of pramipexole, and showed that the removal of the medication was consistent with improvement in frontal-subcortical-mediated cognitive functions. Findings suggest that neuropsychologists should be familiar with the symptoms of ICDs and incorporate such knowledge into their case conceptualizations.
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Affiliation(s)
- Eric R Larson
- a Clement J. Zablocki VA Medical Center, Division of Mental Health , Milwaukee , WI 53295 , USA
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32
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Beaulieu-Boire I, Lang AE. Behavioral effects of levodopa. Mov Disord 2014; 30:90-102. [PMID: 25491470 DOI: 10.1002/mds.26121] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/08/2014] [Accepted: 11/17/2014] [Indexed: 12/15/2022] Open
Abstract
In recent years, levodopa-induced behavioral changes have received increased attention in the medical literature and in clinical practice. The spectrum of these symptoms includes non-motor fluctuations with neuropsychiatric symptoms, compulsive behaviors such as punding, dopamine dysregulation syndrome, and impulse control disorders, psychosis and hallucinations, as well as hypomania and mania. Despite knowledge of the clinical features associated with these behaviors, many of them are probably underdiagnosed. Although the mechanisms underlying behavioral symptoms are still incompletely understood, recent data from imaging and pathological studies have increased our understanding and guided new treatment strategies. Appropriate management remains challenging, because reduction of levodopa (l-dopa) and dopaminergic treatment is often recommended; however, doses required for control of motor symptoms may still induce behavioral changes. Newer modes of delivery of dopaminergic treatment, deep brain stimulation, and nondopaminergic agents may either provide alternatives for treatment of these behavioral problems or permit treatment of parkinsonism with less risk of these behavioral disorders.
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Affiliation(s)
- Isabelle Beaulieu-Boire
- Morton & Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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33
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Zhang G, Zhang Z, Liu L, Yang J, Huang J, Xiong N, Wang T. Impulsive and compulsive behaviors in Parkinson's disease. Front Aging Neurosci 2014; 6:318. [PMID: 25452726 PMCID: PMC4231987 DOI: 10.3389/fnagi.2014.00318] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 10/29/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Impulsive and compulsive behaviors (ICBs) are a heterogeneous group of conditions that may be caused by long-term dopaminergic replacement therapy (DRT) of Parkinson's disease (PD). The spectrum of ICBs includes dopamine dysregulation syndrome (DDS), punding, and impulse control disorders (ICDs). CONTENTS We made a detailed review regarding the epidemiology, pathology, clinical characteristics, risk factors, diagnosis as well as treatment of ICBs. RESULTS The prevalence of ICBs in PD patients is approximately 3-4% for DDS, 0.34-4.2% for punding, and 6-14% for ICDs, with higher prevalence in Western populations than in Asian. Those who take high dose of levodopa are more prone to have DDS, whereas, ICDs are markedly associated with dopamine agonists. Different subtypes of ICBs share many risk factors such as male gender, higher levodopa equivalent daily dose, younger age at PD onset, history of alcoholism, impulsive, or novelty-seeking personality. The Questionnaire for Impulsive-Compulsive Disorder in Parkinson's Disease-Rating Scale seems to be a rather efficacious instrument to obtain relevant information from patients and caregivers. Treatment of ICBs is still a great challenge for clinicians. Readjustment of DRT remains the primary method. Atypical antipsychotics, antidepressants, amantadine, and psychosocial interventions are also prescribed in controlling episodes of psychosis caused by compulsive DRT, but attention should be drawn to balance ICBs symptoms and motor disorders. Moreover, deep brain stimulation of the subthalamic nucleus might be a potential method in controlling ICBs. CONCLUSION The exact pathophysiological mechanisms of ICBs in PD remains poorly understood. Further researches are needed not only to study the pathogenesis, prevalence, features, and risk factors of ICBs, but to find efficacious therapy for patients with these devastating consequences.
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Affiliation(s)
- Guoxin Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Zhentao Zhang
- Department of Neurology, Renmin Hospital of Wuhan University , Wuhan , China
| | - Ling Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Jiaolong Yang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Jinsha Huang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Tao Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
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Yeung EYH, Cavanna AE. Sleep Attacks in Patients With Parkinson's Disease on Dopaminergic Medications: A Systematic Review. Mov Disord Clin Pract 2014; 1:307-316. [PMID: 30363881 DOI: 10.1002/mdc3.12063] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/05/2014] [Accepted: 05/25/2014] [Indexed: 11/05/2022] Open
Abstract
Dopaminergic medications are used as first-line treatment for Parkinson's disease (PD). In 1999, a case series was published describing 9 patients who took dopamine agonists (pramipexole or ropinirole) and experienced sudden irresistible sleep attacks. Sleep attacks have subsequently been reported with other dopaminergic medications, including levodopa. Because these symptoms might not be rare and can affect health-related quality of life, we set out to review the prevalence and clinical characteristics of sleep attacks in patients with PD on dopaminergic medications. We conducted a systematic literature review using the terms parkinson* AND dopamine* AND narcolep* OR sleep attack in multiple databases (PubMed, Embase, and PsycINFO). The systematic literature review yielded 23 relevant articles, including nine case reports or case series and 14 original studies. According to the pooled data from the five studies reporting prevalence figures (n = 10,084), sleep attacks occur in 13.0% of patients with PD on dopaminergic medications. Our analysis failed to show significant differences in the Epworth Sleepiness scores between patients with and without sleep attacks (mean difference: 2.92; 95% confidence interval: -0.47-6.31). The I2 value of 76% indicated high heterogeneity among the studies. Sleep attacks are not a rare occurrence in patients with PD on dopamine agonist treatment. We found conflicting results on whether sleep attacks in PD resemble narcolepsy. The pathophysiology of these symptoms might be related to dopamine D2 and D4 receptor gene polymorphisms. The most effective management strategies were dose reduction and discontinuation of the offending drugs.
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Affiliation(s)
- Eugene Y H Yeung
- College of Medical and Dental Sciences University of Birmingham Birmingham United Kingdom
| | - Andrea E Cavanna
- College of Medical and Dental Sciences University of Birmingham Birmingham United Kingdom.,Department of Neuropsychiatry Birmingham and Solihull Mental Health NHS Foundation Trust Birmingham United Kingdom.,School of Life and Health Sciences Aston University Birmingham United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders University College London and Institute of Neurology London United Kingdom
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Ali M, Liu X, Pillai EN, Chen P, Khor CC, Ong RTH, Teo YY. Characterizing the genetic differences between two distinct migrant groups from Indo-European and Dravidian speaking populations in India. BMC Genet 2014; 15:86. [PMID: 25053360 PMCID: PMC4120727 DOI: 10.1186/1471-2156-15-86] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 07/11/2014] [Indexed: 12/15/2022] Open
Abstract
Background India is home to many ethnically and linguistically diverse populations. It is hypothesized that history of invasions by people from Persia and Central Asia, who are referred as Aryans in Hindu Holy Scriptures, had a defining role in shaping the Indian population canvas. A shift in spoken languages from Dravidian languages to Indo-European languages around 1500 B.C. is central to the Aryan Invasion Theory. Here we investigate the genetic differences between two sub-populations of India consisting of: (1) The Indo-European language speaking Gujarati Indians with genome-wide data from the International HapMap Project; and (2) the Dravidian language speaking Tamil Indians with genome-wide data from the Singapore Genome Variation Project. Results We implemented three population genetics measures to identify genomic regions that are significantly differentiated between the two Indian populations originating from the north and south of India. These measures singled out genomic regions with: (i) SNPs exhibiting significant variation in allele frequencies in the two Indian populations; and (ii) differential signals of positive natural selection as quantified by the integrated haplotype score (iHS) and cross-population extended haplotype homozygosity (XP-EHH). One of the regions that emerged spans the SLC24A5 gene that has been functionally shown to affect skin pigmentation, with a higher degree of genetic sharing between Gujarati Indians and Europeans. Conclusions Our finding points to a gene-flow from Europe to north India that provides an explanation for the lighter skin tones present in North Indians in comparison to South Indians.
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Affiliation(s)
| | | | | | | | | | | | - Yik-Ying Teo
- Life Sciences Institute, National University of Singapore, Singapore, Singapore.
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36
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Lhommée E, Batir A, Quesada JL, Ardouin C, Fraix V, Seigneuret E, Chabardès S, Benabid AL, Pollak P, Krack P. Dopamine and the biology of creativity: lessons from Parkinson's disease. Front Neurol 2014; 5:55. [PMID: 24795692 PMCID: PMC4001035 DOI: 10.3389/fneur.2014.00055] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/03/2014] [Indexed: 01/09/2023] Open
Abstract
Background: Parkinson’s disease (PD) is characterized by reduced flexibility, conceptualization, and visuo-spatial abilities. Although these are essential to creativity, case studies show emergence of creativity during PD. Knowledge about the role of dopamine in creativity so far only stems from a few case reports. We aim at demonstrating that creativity can be induced by dopaminergic treatments in PD, and tends to disappear after withdrawal of dopamine agonists. Methods: Eleven consecutive creative PD patients were selected from candidates for subthalamic nucleus deep brain stimulation (STN DBS) surgery, and compared to 22 non-creative control PD patients. Motor disability (UPDRS III), cognition (Frontal score, Mattis scale), and behavior (Ardouin scale) were assessed before surgery and 1 year after. Results: Before surgery, whereas cognitive and motor assessments were similar between groups, dopamine agonist (but not levodopa) dosages were higher in creative patients (p = 0.01). The Ardouin scale revealed also a specific psycho-behavioral profile of creative patients which had higher scores for mania (p < 0.001), hobbyism (p = 0.001), nocturnal hyperactivity (p = 0.041), appetitive functioning (p = 0.003), and ON euphoria (p = 0.007) and lower scores for apathy and OFF dysphoria (p = 0.04 for each). Post-operative motor, cognitive, and behavioral scores as dopaminergic treatment dosages were equivalent between groups. Motor improvement allowed for a 68.6% decrease in dopaminergic treatment. Only 1 of the 11 patients remained creative after surgery. Reduction of dopamine agonist was significantly correlated to the decrease in creativity in the whole population of study (Spearman correlation coefficient ρ = 0.47 with confidence index of 95% = 0.16; 0.70, p = 0.0053). Conclusion: Creativity in PD is linked to dopamine agonist therapy, and tends to disappear after STN DBS in parallel to reduction of dopamine agonists, which are relatively selective for the mesolimbic D3 dopamine receptors.
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Affiliation(s)
- Eugénie Lhommée
- U836, INSERM , Grenoble , France ; University of Grenoble Alpes, GIN , Grenoble , France ; Movement Disorder Unit, CHU de Grenoble , Grenoble , France
| | - Alina Batir
- U836, INSERM , Grenoble , France ; University of Grenoble Alpes, GIN , Grenoble , France ; Movement Disorder Unit, CHU de Grenoble , Grenoble , France
| | - Jean-Louis Quesada
- Centre d'Investigation Clinique, CHU de Grenoble, Université Joseph Fourier , Grenoble , France
| | - Claire Ardouin
- U836, INSERM , Grenoble , France ; University of Grenoble Alpes, GIN , Grenoble , France ; Movement Disorder Unit, CHU de Grenoble , Grenoble , France
| | - Valérie Fraix
- U836, INSERM , Grenoble , France ; University of Grenoble Alpes, GIN , Grenoble , France ; Movement Disorder Unit, CHU de Grenoble , Grenoble , France
| | - Eric Seigneuret
- U836, INSERM , Grenoble , France ; University of Grenoble Alpes, GIN , Grenoble , France ; Department of Neurosurgery, CHU de Grenoble , Grenoble , France
| | - Stéphan Chabardès
- U836, INSERM , Grenoble , France ; University of Grenoble Alpes, GIN , Grenoble , France ; Department of Neurosurgery, CHU de Grenoble , Grenoble , France
| | | | - Pierre Pollak
- U836, INSERM , Grenoble , France ; University of Grenoble Alpes, GIN , Grenoble , France ; Movement Disorder Unit, CHU de Grenoble , Grenoble , France
| | - Paul Krack
- U836, INSERM , Grenoble , France ; University of Grenoble Alpes, GIN , Grenoble , France ; Movement Disorder Unit, CHU de Grenoble , Grenoble , France
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Yuvaraj R, Murugappan M, Mohamed Ibrahim N, Iqbal M, Sundaraj K, Mohamad K, Palaniappan R, Mesquita E, Satiyan M. On the analysis of EEG power, frequency and asymmetry in Parkinson's disease during emotion processing. Behav Brain Funct 2014; 10:12. [PMID: 24716619 PMCID: PMC4234023 DOI: 10.1186/1744-9081-10-12] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/10/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE While Parkinson's disease (PD) has traditionally been described as a movement disorder, there is growing evidence of disruption in emotion information processing associated with the disease. The aim of this study was to investigate whether there are specific electroencephalographic (EEG) characteristics that discriminate PD patients and normal controls during emotion information processing. METHOD EEG recordings from 14 scalp sites were collected from 20 PD patients and 30 age-matched normal controls. Multimodal (audio-visual) stimuli were presented to evoke specific targeted emotional states such as happiness, sadness, fear, anger, surprise and disgust. Absolute and relative power, frequency and asymmetry measures derived from spectrally analyzed EEGs were subjected to repeated ANOVA measures for group comparisons as well as to discriminate function analysis to examine their utility as classification indices. In addition, subjective ratings were obtained for the used emotional stimuli. RESULTS Behaviorally, PD patients showed no impairments in emotion recognition as measured by subjective ratings. Compared with normal controls, PD patients evidenced smaller overall relative delta, theta, alpha and beta power, and at bilateral anterior regions smaller absolute theta, alpha, and beta power and higher mean total spectrum frequency across different emotional states. Inter-hemispheric theta, alpha, and beta power asymmetry index differences were noted, with controls exhibiting greater right than left hemisphere activation. Whereas intra-hemispheric alpha power asymmetry reduction was exhibited in patients bilaterally at all regions. Discriminant analysis correctly classified 95.0% of the patients and controls during emotional stimuli. CONCLUSION These distributed spectral powers in different frequency bands might provide meaningful information about emotional processing in PD patients.
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Affiliation(s)
- Rajamanickam Yuvaraj
- School of Mechatronic Engineering, Universiti Malaysia Perlis (UniMAP), Arau, Malaysia.
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38
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Connolly BS, Fox SH. Drug treatments for the neuropsychiatric complications of Parkinson’s disease. Expert Rev Neurother 2014; 12:1439-49. [DOI: 10.1586/ern.12.142] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
Stereotypies that develop spontaneously in nonhuman primates can provide an effective model for repetitive stereotyped behavior in people with neurodevelopmental or obsessive-compulsive disorders. The behaviors are similar in form, are similarly affected by environmental conditions, and are improved with similar treatment methods such as enrichment, training, and drug therapy. However, because of a greater number of commonalities in these factors, nonhuman primates may serve as a better model for stereotyped behavior in individuals with autism or intellectual disability than for compulsions in individuals with obsessive-compulsive disorder. Because animal models may not be exact in all features of the disorder being studied, it is important to investigate the strengths and weaknesses of using a nonhuman primate model for stereotyped behavior in people with psychological disorders.
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McGonigal A, Chauvel P. Prefrontal seizures manifesting as motor stereotypies. Mov Disord 2013; 29:1181-5. [DOI: 10.1002/mds.25718] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/12/2013] [Accepted: 09/22/2013] [Indexed: 02/03/2023] Open
Affiliation(s)
- Aileen McGonigal
- Institut de Neurosciences des Systèmes; INSERM UMR 1106; Marseille France
- Aix Marseille Université; Faculté de Médecine; Marseille France
- Service de Neurophysiologie Clinique; Hôpital de la Timone; Assistance Publique des Hôpitaux de Marseille; Marseille France
| | - Patrick Chauvel
- Institut de Neurosciences des Systèmes; INSERM UMR 1106; Marseille France
- Aix Marseille Université; Faculté de Médecine; Marseille France
- Service de Neurophysiologie Clinique; Hôpital de la Timone; Assistance Publique des Hôpitaux de Marseille; Marseille France
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Repetitive transcranial magnetic stimulation transiently reduces punding in Parkinson's disease: a preliminary study. J Neural Transm (Vienna) 2013; 121:267-74. [PMID: 24132699 DOI: 10.1007/s00702-013-1100-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/06/2013] [Indexed: 10/26/2022]
Abstract
Amongst the impulse-control disorders (ICDs) associated with dopamine-replacement therapy in patients with Parkinson's disease (PD) is a repetitive, complex, stereotyped behaviour called punding. Disruption of the reciprocal loops between the striatum and structures in the prefrontal cortex (PFC) following dopamine depletion may predispose patients with PD to these behavioural disorders. The purpose of the present study was to assess the effects of repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral PFC (DLPFC) on punding in PD. We used low-frequency (LF) rTMS in four PD patients presenting with punding. Punding was transiently reversed by LF-rTMS over the DLPFC without enhancing motor impairment. The effect was more sustained after right DLPFC rTMS. Therefore, LF-rTMS produced a transient beneficial effect in PD patients with punding, similar to that reported in PD patients with levodopa-induced dyskinesias. rTMS might have therapeutic potential for the treatment of punding and perhaps other ICDs in PD.
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El Otmani H, Raji L, El Moutaouakil B, Rafai MA, Slassi I. [Severe punding in Parkinson's disease]. L'ENCEPHALE 2013; 41:190-3. [PMID: 24095293 DOI: 10.1016/j.encep.2013.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 03/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Punding is a stereotypical behavior characterized by an intense fascination with repetitive handling and examining of mechanical devices or arranging common objects. This condition, which is different from both obsessive-compulsive disorder and mania, is still underestimated in patients with Parkinson's disease and may have deleterious social consequences on patients and their families. CASE REPORT We report the case of severe punding in a 23-year-old parkinsonian woman, who presented, a few days following a rise in the dose of pergolide up to 2,5 mg/(d), frequent and daily unusual repetitive behavior, characterized by ceaseless sewing, disassembly and reassembly of phones, and coloring of drawings. These behaviors were associated with a common peak of dose dyskinesia and were responsible for a considerable reduction in duration of sleep with negative impact on the quality of life of her parents. These symptoms significantly improved immediately after switching pergolide to an equivalent dose of ropinirole (12 mg/(d). DISCUSSION Punding has only recently come to the attention of physicians through the first report in a parkinsonian patient, triggered by dopaminergic replacement therapy. The phenomenon was thought to be related to excessive dopaminergic stimulation of the limbic and associative pathways. The current mainstay of treatment is the reduction in the dose of dopaminergic medication or changing the presumed responsible drug, often a dopaminergic agonist. In this article, the authors review the epidemiology, pathophysiology and management of this curious phenomenon.
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Affiliation(s)
- H El Otmani
- Service de neurologie, CHU Ibn Rochd, Casablanca, Maroc.
| | - L Raji
- Service de neurologie, CHU Ibn Rochd, Casablanca, Maroc
| | | | - M A Rafai
- Service de neurologie, CHU Ibn Rochd, Casablanca, Maroc
| | - I Slassi
- Service de neurologie, CHU Ibn Rochd, Casablanca, Maroc
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Macphee GJA, Chaudhuri KR, David AS, Worth P, Wood B. Managing impulse control behaviours in Parkinson's disease: practical guidelines. Br J Hosp Med (Lond) 2013; 74:160-6. [PMID: 23665786 DOI: 10.12968/hmed.2013.74.3.160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bastiaens J, Dorfman BJ, Christos PJ, Nirenberg MJ. Prospective cohort study of impulse control disorders in Parkinson's disease. Mov Disord 2013; 28:327-33. [PMID: 23283708 DOI: 10.1002/mds.25291] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/21/2012] [Accepted: 10/24/2012] [Indexed: 12/18/2022] Open
Abstract
Impulse control disorders (ICDs) are potentially serious side effects of dopamine agonist therapy in Parkinson's disease (PD), but prospective data are lacking about their incidence, time course, and risk factors. This work was a 4-year, prospective cohort study of outpatients with PD and no previous ICDs (N = 164). All subjects treated with a dopamine agonist during the study were followed longitudinally for new-onset ICDs. Baseline characteristics were compared in groups with (ICD+) and without (ICD-) subsequent ICDs. Forty-six subjects were treated with a dopamine agonist, including 25 who were newly treated and 21 who received ongoing dopamine agonist therapy. Of these 46 subjects, 18 (39.1%) developed new-onset ICDs. The timing of ICD onset varied from 3.0 to 114.0 months (median, 23.0) after initiation of dopamine agonist therapy. Baseline demographic characteristics were similar in ICD+ and ICD- groups. At baseline, ICD+ subjects had a greater prevalence of motor complications (61.1% versus 25.0%; P = 0.01) than ICD- subjects, despite comparable total dopaminergic medication usage in both groups (median, 150.0 versus 150.0 levodopa equivalents; P = 0.61). Compared with ICD- subjects, ICD+ subjects had a greater baseline prevalence of caffeine use (100% versus 66.7%; P = 0.007) and higher lifetime prevalence of cigarette smoking (44.4% versus 14.3%; P = 0.04). Peak dopamine agonist doses were higher in ICD+ than ICD- subjects (median 300.0 versus 165.0 L-dopa equivalents; P = 0.03), but cumulative dopamine agonist exposure was similar in both groups. In summary, the timing of new-onset ICDs in PD is highly variable. Risk factors include cigarette smoking, caffeine use, motor complications, and higher peak dopamine agonist dosage.
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Affiliation(s)
- Jesse Bastiaens
- Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, New York, USA
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Some molecular mechanisms of dopaminergic and glutamatergic dysfunctioning in Parkinson’s disease. J Neural Transm (Vienna) 2012. [DOI: 10.1007/s00702-012-0930-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Mizuno Y. An update on the management of juvenile and young-onset Parkinson’s disease. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Early-onset Parkinson’s disease (PD) denotes onset of the disease below the age of 40 years. Patients tend to have a slower disease progression, an increased rate of dystonia, an increased rate of dyskinesias in response to L-3,4-dihydroxyphenylalanine and a lower rate of dementia compared with those in late-onset PD. Early-onset PD patients may experience more social and psychosocial conflict compared with late-onset patients and these factors would contribute to greater impairment of quality of life. Unemployment due to disability or early retirement may be causes for these conflicts. We have to take these factors into account whenever we institute drug therapy in early-onset PD. There is no randomized controlled study on early-onset PD; however, we may make a reasonable decision by considering the data on PD in general and clinical characteristics of early-onset patients. The management of motor and non-motor symptoms of early-onset PD patients is reviewed here.
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Affiliation(s)
- Yoshikuni Mizuno
- Department of Neuroregenerative Medicine, Kitasato University School of Medicine, Kanagawa & Department of Neurology, Juntendo University School of Medicine, Kanagawa 2-1-1 Asamizodai, Minamiku, Sagamihara, 252-0360 Kanagawa, Japan
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Witjas T, Eusebio A, Fluchère F, Azulay JP. Addictive behaviors and Parkinson's disease. Rev Neurol (Paris) 2012; 168:624-33. [DOI: 10.1016/j.neurol.2012.06.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 06/28/2012] [Accepted: 06/28/2012] [Indexed: 10/28/2022]
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Lhommée E, Klinger H, Thobois S, Schmitt E, Ardouin C, Bichon A, Kistner A, Fraix V, Xie J, Aya Kombo M, Chabardès S, Seigneuret E, Benabid AL, Mertens P, Polo G, Carnicella S, Quesada JL, Bosson JL, Broussolle E, Pollak P, Krack P. Subthalamic stimulation in Parkinson's disease: restoring the balance of motivated behaviours. ACTA ACUST UNITED AC 2012; 135:1463-77. [PMID: 22508959 DOI: 10.1093/brain/aws078] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Addictions to dopaminergic drugs or to pleasant behaviours are frequent and potentially devastating neuropsychiatric disorders observed in Parkinson's disease. They encompass impulse control disorders, punding and dopamine dysregulation syndrome. A relationship with dopaminergic treatment is strongly suggested. Subthalamic stimulation improves motor complications and allows for drastic reductions in medication. This treatment might, therefore, be considered for patients with behavioural addictions, when attempts to reduce dopaminergic medication have failed. However, conflicting data have reported suppression, alleviation, worsening or new onset of behavioural addictions after subthalamic stimulation. Non-motor fluctuations are also a disabling feature of the disease. We prospectively investigated behaviour in a cohort of 63 patients with Parkinson's disease, before and 1 year after subthalamic stimulation using the Ardouin scale, with systematic evaluation of functioning in overall appetitive or apathetic modes, non-motor fluctuations, dopaminergic dysregulation syndrome, as well as behavioural addictions (including impulse control disorders and punding) and compulsive use of dopaminergic medication. Defined drug management included immediate postoperative discontinuation of dopamine agonists and reduction in levodopa. Motor and cognitive statuses were controlled (Unified Parkinson's Disease Rating Scale, Mattis Dementia Rating Scale, frontal score). After surgery, the OFF medication motor score improved (-45.2%), allowing for a 73% reduction in dopaminergic treatment, while overall cognitive evaluation was unchanged. Preoperative dopamine dysregulation syndrome had disappeared in 4/4, behavioural addictions in 17/17 and compulsive dopaminergic medication use in 9/9 patients. New onset of levodopa abuse occurred in one patient with surgical failure. Non-motor fluctuations were significantly reduced with improvements in off-dysphoria (P ≤ 0.001) and reduction in on-euphoria (P ≤ 0.001). There was an inversion in the number of patients functioning in an overall appetitive mode (29 before versus 2 after surgery, P ≤ 0.0001) to an overall apathetic mode (3 before versus 13 after surgery, P < 0.05). Two patients attempted suicide. Improvement in motor fluctuations is linked to the direct effect of stimulation on the sensory-motor subthalamic territory, while improvement in dyskinesias is mainly explained by an indirect effect related to the decrease in dopaminergic drugs. Our data suggest that non-motor fluctuations could similarly be directly alleviated through stimulation of the non-motor subthalamic territories, and hyperdopaminergic side effects might improve mainly due to the decrease in dopaminergic medication. We show an overall improvement in neuropsychiatric symptomatology and propose that disabling non-motor fluctuations, dopaminergic treatment abuse and drug-induced behavioural addictions in Parkinson's disease may be considered as new indications for subthalamic stimulation.
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Affiliation(s)
- Eugénie Lhommée
- CHU de Grenoble, Pavillon de neurology, Grenoble Cedex 9, France.
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Impulsive and compulsive behaviors in Parkinson's disease: A one-year follow-up study. J Neurol Sci 2011; 310:197-201. [DOI: 10.1016/j.jns.2011.05.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 05/09/2011] [Accepted: 05/27/2011] [Indexed: 11/21/2022]
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Katzenschlager R. Dopaminergic dysregulation syndrome in Parkinson's disease. J Neurol Sci 2011; 310:271-5. [DOI: 10.1016/j.jns.2011.07.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 06/15/2011] [Accepted: 07/11/2011] [Indexed: 01/08/2023]
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