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Turcano P, Jacobson J, Ghoniem K, Mullan A, Camerucci E, Stang C, Piat C, Bower JH, Savica R. Impulse control disorders and use of dopamine agonists in early onset Parkinson's disease. Front Neurol 2024; 15:1404904. [PMID: 38841693 PMCID: PMC11150809 DOI: 10.3389/fneur.2024.1404904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Impulse control disorders (ICDs) are defined as excessive and repetitive behaviors that may affect Parkinson's disease (PD) patients exposed to dopamine agonists. Current data on ICDs in patients with early-onset Parkinson's disease (EOPD) is lacking. In this study we aim to assess the frequency of use of dopamine agonists, the prevalence of ICDs, and to explore potential factors associated with their development in patients with EOPD. Methods We used the Mayo Clinic Data Explorer system to investigate a population-based cohort of EOPD patients between 1990 and 2022 at Mayo Clinic, Rochester, MN. We used ICD coding for parkinsonism; then, we reviewed all the clinical records and included only those patients with a clinical diagnosis of PD with symptoms onset at or before the age of 50, and who developed ICDs after using therapeutic doses of dopamine agonists. Results A total of 831 (513 males and 318 females) patients with EOPD were included with a median age at symptom onset of 42 years of age (CI: 37-46). Dopamine agonists were used in 49.7% of all patients; of these, only 14.5% developed symptoms of one or more ICDs. Hypersexuality was the most commonly observed ICD (38.3%), and the only one having a statistically significant male predominance (p = 0.011). Conclusion ICDs are common in EOPD, particularly when associated with the use of dopamine agonists.
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Affiliation(s)
| | - Jessie Jacobson
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Khaled Ghoniem
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Aidan Mullan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Emanuele Camerucci
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Cole Stang
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Capucine Piat
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - James H. Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Fabbri M, Barbosa R, Rascol O. Off-time Treatment Options for Parkinson's Disease. Neurol Ther 2023; 12:391-424. [PMID: 36633762 PMCID: PMC10043092 DOI: 10.1007/s40120-022-00435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Motor fluctuations (MF) are deemed by patients with Parkinson's disease (PD) as the most troublesome disease feature resulting from the increasing impairment in responsiveness to dopaminergic drug treatments. MF are characterized by the loss of a stable response to levodopa over the nychthemeron with the reappearance of motor (and non-motor) parkinsonian clinical signs at various moments during the day and night. They normally appear after a few years of levodopa treatment and with a variable, though overall increasing severity, over the disease course. The armamentarium of first-line treatment options has widened in the last decade with new once-a-daily compounds, including a catechol O-methyltransferase inhibitor - Opicapone-, two MAO-B inhibitors plus channel blocker - Zonisamide and Safinamide and one amantadine extended-release formulation - ADS5012. In addition to apomorphine injection or oral levodopa dispersible tablets, which have been available for a long time, new on-demand therapies such as apomorphine sublingual or levodopa inhaled formulations have recently shown efficacy as rescue therapies for Off-time treatment. When the management of MF becomes difficult in spite of oral/on-demand options, more complex therapies should be considered, including surgical, i.e. deep brain stimulation, or device-aided therapies with pump systems delivering continuous subcutaneous or intestinal levodopa or subcutaneous apomorphine formulation. Older and less commonly used ablative techniques (radiofrequency pallidotomy) may also be effective while there is still scarce data regarding Off-time reduction using a new lesional approach, i.e. magnetic resonance-guided focused ultrasound. The choice between the different advanced therapies options is a shared decision that should consider physician opinion on contraindication/main target symptom, patients' preference, caregiver's availability together with public health systems and socio-economic environment. The choice of the right/first add-on treatment is still a matter of debate as well as the proper time for an advanced therapy to be considered. In this narrative review, we discuss all the above cited aspects of MF in patients with PD, including their phenomenology, management, by means of pharmacological and advanced therapies, on-going clinical trials and future research and treatment perspectives.
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Affiliation(s)
- Margherita Fabbri
- Department of Clinical Pharmacology and Neurosciences, Toulouse Parkinson Expert Centre, Toulouse NeuroToul Center of Excellence in Neurodegeneration (COEN), French NS-Park/F-CRIN Network, University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France.
| | - Raquel Barbosa
- Department of Clinical Pharmacology and Neurosciences, Toulouse Parkinson Expert Centre, Toulouse NeuroToul Center of Excellence in Neurodegeneration (COEN), French NS-Park/F-CRIN Network, University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France.,Department of Neurology, Hospital de Egas Moniz Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas Universidade Nova de Lisboa, Lisbon, Portugal
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neurosciences, Toulouse Parkinson Expert Centre, Toulouse NeuroToul Center of Excellence in Neurodegeneration (COEN), French NS-Park/F-CRIN Network, University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France
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Weintraub D, Aarsland D, Biundo R, Dobkin R, Goldman J, Lewis S. Management of psychiatric and cognitive complications in Parkinson's disease. BMJ 2022; 379:e068718. [PMID: 36280256 DOI: 10.1136/bmj-2021-068718] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neuropsychiatric symptoms (NPSs) such as affective disorders, psychosis, behavioral changes, and cognitive impairment are common in Parkinson's disease (PD). However, NPSs remain under-recognized and under-treated, often leading to adverse outcomes. Their epidemiology, presentation, risk factors, neural substrate, and management strategies are incompletely understood. While psychological and psychosocial factors may contribute, hallmark PD neuropathophysiological changes, plus the associations between exposure to dopaminergic medications and occurrence of some symptoms, suggest a neurobiological basis for many NPSs. A range of psychotropic medications, psychotherapeutic techniques, stimulation therapies, and other non-pharmacological treatments have been studied, are used clinically, and are beneficial for managing NPSs in PD. Appropriate management of NPSs is critical for comprehensive PD care, from recognizing their presentations and timing throughout the disease course, to the incorporation of different therapeutic strategies (ie, pharmacological and non-pharmacological) that utilize a multidisciplinary approach.
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Affiliation(s)
- Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
| | - Roberta Biundo
- Department of General Psychology, University of Padua, Padua, Italy
- Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Roseanne Dobkin
- Department of Psychiatry, Rutgers-The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jennifer Goldman
- Shirley Ryan AbilityLab, Parkinson's Disease and Movement Disorders, Chicago, IL
- Departments of Physical Medicine and Rehabilitation and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
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Healy S, Shepherd H, Mooney N, Da Costa A, Osman-Farah J, Macerollo A. The effect of deep brain stimulation on impulse control related disorders in Parkinson's disease - A 10-year retrospective study of 137 patients. J Neurol Sci 2022; 440:120339. [PMID: 35853293 DOI: 10.1016/j.jns.2022.120339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/14/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Sarah Healy
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK
| | - Hilary Shepherd
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK; University of Liverpool Medical School, Liverpool, UK
| | - Nicole Mooney
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK
| | - Antonio Da Costa
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK
| | - Jibril Osman-Farah
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK
| | - Antonella Macerollo
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK.
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Nascent visual artistic expression following right hemisphere subthalamic nucleus deep brain stimulation for Parkinson's disease. Parkinsonism Relat Disord 2022; 99:47-50. [PMID: 35598419 DOI: 10.1016/j.parkreldis.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/20/2022]
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Effect of deep brain stimulation on impulse control behaviors of Parkinson’s disease patients: A systematic review and meta-analysis. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lo Buono V, Lucà Trombetta M, Palmeri R, Bonanno L, Cartella E, Di Lorenzo G, Bramanti P, Marino S, Corallo F. Subthalamic nucleus deep brain stimulation and impulsivity in Parkinson's disease: a descriptive review. Acta Neurol Belg 2021; 121:837-847. [PMID: 33961279 PMCID: PMC8349322 DOI: 10.1007/s13760-021-01684-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
Standard treatment of Parkinson’s disease involves the dopaminergic medications. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an important neurosurgical intervention often used as alternative treatment to drug therapy; however, it can be associated with increase of impulsive behaviors. This descriptive review focused on studies investigating the correlation between Deep brain stimulation of the subthalamic nucleus and impulsivity in Parkinson’s disease patients, arguing, the action’s mechanism and the specific role of the subthalamic nucleus. We searched on PubMed and Web of Science databases and screening references of included studies and review articles for additional citations. From initial 106 studies, only 15 met the search criteria. Parkinson’s Disease patients with and without Deep Brain Stimulation were compared with healthy controls, through 16 different tasks that assessed some aspects of impulsivity. Both Deep brain stimulation of the subthalamic nucleus and medication were associated with impulsive behavior and influenced decision-making processes. Moreover, findings demonstrated that: Impulse Control Disorders (ICDs) occurred soon after surgery, while, in pharmacological treatment, they appeared mainly after the initiation of treatment or the increase in dosage, especially with dopamine agonists. The subthalamic nucleus plays a part in the fronto-striato-thalamic-cortical loops mediating motor, cognitive, and emotional functions: this could explain the role of the Deep Brain Stimulation in behavior modulation in Parkinson’s Disease patients. Indeed, increase impulsivity has been reported also after deep brain stimulation of the subthalamic nucleus independently by dopaminergic medication status.
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Affiliation(s)
| | | | | | - Lilla Bonanno
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | | | | | - Silvia Marino
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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Salles PA, Mata IF, Fernandez HH. Should we start integrating genetic data in decision-making on device-aided therapies in Parkinson disease? A point of view. Parkinsonism Relat Disord 2021; 88:51-57. [PMID: 34119931 DOI: 10.1016/j.parkreldis.2021.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 12/14/2022]
Abstract
Parkinson disease (PD) is a complex heterogeneous neurodegenerative disorder. Association studies have revealed numerous genetic risk loci and variants, and about 5-10% suffer from a monogenic form. Because the presentation and course of PD is unique to each patient, personalized symptomatic treatment should ideally be offered to treat the most disabling motor and non-motor symptoms. Indeed, clinical milestones and treatment complications that appear during disease progression are influenced by the genetic imprint. With recent advances in PD, more patients live longer to become eligible for device-aided therapies, such as apomorphine continuous subcutaneous infusion, levodopa duodenal gel infusion, and deep brain stimulation surgery, each with its own inclusion and exclusion criteria, advantages and disadvantages. Because genetic variants influence the expression of particular clinical profiles, factors for better or worse outcomes for device-aided therapies may then be proactively identified. For example, mutations in PRKN, LRRK2 and GBA express phenotypes that favor suitability for different device therapies, although with marked differences in the therapeutic window; whereas multiplications of SNCA express phenotypes that make them less desirable for device therapies.
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Affiliation(s)
- Philippe A Salles
- Center for Neurological Restoration, Cleveland Clinic Neurological Institute, OH, USA; Movement Disorders Center, CETRAM, Santiago, Chile.
| | - Ignacio F Mata
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Hubert H Fernandez
- Center for Neurological Restoration, Cleveland Clinic Neurological Institute, OH, USA.
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9
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Impulse control disorders and related behaviors in Parkinson's disease: risk factors, clinical and genetic aspects, and management. Curr Opin Neurol 2021; 34:547-555. [PMID: 33967198 DOI: 10.1097/wco.0000000000000955] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review recent findings and research directions on impulse control disorders and related behaviors (ICDRBs) in Parkinson's disease (PD). RECENT FINDINGS Longitudinal studies found that prevalence increases during PD progression, incident ICDRBs being around 10% per year in patients treated with dopaminergic therapies. Screening tools and severity scales already developed have been validated and are available in several countries and languages. The main clinical risk factors include young age, male gender, type, doses and duration of dopaminergic therapy, PD motor severity and dyskinesia, depression, anxiety, apathy, sleep disorders, and impulsivity traits. Genetic factors are suspected by a high estimated heritability, but individual genes and variants remain to be replicated. Management of ICDRBs is centered on dopamine agonist decrease, with the risk to develop withdrawal symptoms. Cognitive behavioral therapy and subthalamic nucleus deep brain stimulation also improve ICDRBs. In the perspective of precision medicine, new individual prediction models of these disorders have been proposed, but they need further independent replication. SUMMARY Regular monitoring of ICDRB during the course of PD is needed, particularly in the subject at high risk of developing these complications. Precision medicine will require the appropriate use of machine learning to be reached in the clinical setting.
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10
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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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Santin MDN, Voulleminot P, Vrillon A, Hainque E, Béreau M, Lagha‐Boukbiza O, Wirth T, Montaut S, Bardinet E, Kyheng M, Rolland A, Voirin J, Drapier S, Durif F, Eusebio A, Giordana C, Auzou N, Houeto J, Hubsch C, Jarraya B, Laurencin C, Maltete D, Meyer M, Rascol O, Rouaud T, Tir M, Moreau C, Corvol J, Proust F, Grabli D, Devos D, Tranchant C, Anheim M. Impact of Subthalamic Deep Brain Stimulation on Impulse Control Disorders in Parkinson's Disease: A Prospective Study. Mov Disord 2020; 36:750-757. [DOI: 10.1002/mds.28320] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Paul Voulleminot
- Department of Neurology NS‐PARK/F‐CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg Strasbourg France
| | - Agathe Vrillon
- Department of Neurology NS‐PARK/F‐CRIN, Assistance Publique ‐ Hôpitaux de Paris (APHP), Pitié‐Salpêtrière Hospital Paris France
| | - Elodie Hainque
- Department of Neurology NS‐PARK/F‐CRIN, Assistance Publique ‐ Hôpitaux de Paris (APHP), Pitié‐Salpêtrière Hospital Paris France
- Sorbonne Universités, Assistance Publique ‐ Hôpitaux de Paris (APHP), Inserm, CNRS, Institut du Cerveau et de la Moelle (ICM) Paris France
| | - Matthieu Béreau
- Department of Neurology NS‐PARK/F‐CRIN, University Hospital of Besançon Besançon France
| | - Ouhaid Lagha‐Boukbiza
- Department of Neurology NS‐PARK/F‐CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg Strasbourg France
| | - Thomas Wirth
- Department of Neurology NS‐PARK/F‐CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg Strasbourg France
| | - Solveig Montaut
- Department of Neurology NS‐PARK/F‐CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg Strasbourg France
| | - Eric Bardinet
- Department of Neurology NS‐PARK/F‐CRIN, University Hospital of Besançon Besançon France
- Centre de Neuroimagerie de Recherche, Institut du Cerveau et de la Moelle (ICM) Paris France
| | - Maeva Kyheng
- Department of Clinical Research Lille University Hospital Lille France
| | - Anne‐Sophie Rolland
- Department of Medical Pharmacology University Hospital, NS‐PARK/F‐CRIN, University of Lille, Lille Neuroscience & Cognition, Inserm, UMR‐S1172 Lille France
| | - Jimmy Voirin
- Department of Neurosurgery, NS‐PARK/F‐CRIN Strasbourg University Hospital Strasbourg France
| | - Sophie Drapier
- Department of Neurology NS‐PARK/F‐CRIN, University Hospital of Rennes Rennes France
| | - Franck Durif
- Department of Neurology NS‐PARK/F‐CRIN, CHU Clermont‐Ferrand Clermont‐Ferrand France
| | - Alexandre Eusebio
- Department of Neurology NS‐PARK/F‐CRIN, Assistance Publique ‐ Hôpitaux de Marseille (APHM), Timone University Hospital and Institut de Neurosciences de la Timone Marseille France
| | - Caroline Giordana
- Department of Neurology NS‐PARK/F‐CRIN, Centre Hospitalier Universitaire de Nice Nice France
| | - Nicolas Auzou
- Institute of Neurodegenerative Disorders NS‐PARK/F‐CRIN, University Hospital of Bordeaux Bordeaux France
| | - Jean‐Luc Houeto
- Department of Neurology NS‐PARK/F‐CRIN, University Hospital of Poitiers Poitiers France
| | - Cécile Hubsch
- Department of Neurology NS‐PARK/F‐CRIN, Fondation Ophtalmologique Adolphe de Rothschild Paris France
| | - Béchir Jarraya
- Neuroscience Pole NS‐PARK/F‐CRIN, Hôpital Foch, Suresnes, University of Versailles Paris‐Saclay, INSERM‐CEA NeuroSpin Saclay France
| | - Chloé Laurencin
- Department of Neurology NS‐PARK/F‐CRIN, University Hospital of Lyon Lyon France
| | - David Maltete
- Department of Neurology NS‐PARK/F‐CRIN, Rouen University Hospital and University of Rouen, France; INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication Mont‐Saint‐Aignan France
| | - Mylène Meyer
- Department of Neurology NS‐PARK/F‐CRIN, University Hospital of Nancy Nancy France
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neuroscience NS‐Park/F‐CRIN, Toulouse University Hospital Toulouse France
| | - Tiphaine Rouaud
- Department of Neurology NS‐PARK/F‐CRIN, Nantes University Hospital Nantes France
| | - Mélissa Tir
- Department of Neurology NS‐PARK/FCRIN, Amiens University Hospital Amiens France
| | - Caroline Moreau
- Department of Neurology University Hospital, NS‐PARK/F‐CRIN, University of Lille, Lille Neuroscience & Cognition, INSERM, UMR‐S1172 Lille France
| | - Jean‐Christophe Corvol
- Department of Neurology NS‐PARK/F‐CRIN, Assistance Publique ‐ Hôpitaux de Paris (APHP), Pitié‐Salpêtrière Hospital Paris France
- Sorbonne Universités, Assistance Publique ‐ Hôpitaux de Paris (APHP), Inserm, CNRS, Institut du Cerveau et de la Moelle (ICM) Paris France
| | - François Proust
- Department of Neurosurgery, NS‐PARK/F‐CRIN Strasbourg University Hospital Strasbourg France
| | - David Grabli
- Department of Neurology NS‐PARK/F‐CRIN, Assistance Publique ‐ Hôpitaux de Paris (APHP), Pitié‐Salpêtrière Hospital Paris France
| | - David Devos
- Department of Medical Pharmacology University Hospital, NS‐PARK/F‐CRIN, University of Lille, Lille Neuroscience & Cognition, Inserm, UMR‐S1172 Lille France
- Department of Neurology University Hospital, NS‐PARK/F‐CRIN, University of Lille, Lille Neuroscience & Cognition, INSERM, UMR‐S1172 Lille France
| | - Christine Tranchant
- Department of Neurology NS‐PARK/F‐CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg Strasbourg France
| | - Mathieu Anheim
- Department of Neurology NS‐PARK/F‐CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg Strasbourg France
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The role of dopamine pharmacotherapy and addiction-like behaviors in Parkinson's disease. Prog Neuropsychopharmacol Biol Psychiatry 2020; 102:109942. [PMID: 32272129 DOI: 10.1016/j.pnpbp.2020.109942] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 12/19/2022]
Abstract
Addictions involve a spectrum of behaviors that encompass features of impulsivity and compulsivity, herein referred to as impulsive-compulsive spectrum disorders (ICSDs). The etiology of ICSDs likely involves a complex interplay among neurobiological, psychological and social risk factors. Neurobiological risk factors include the status of the neuroanatomical circuits that govern ICSDs. These circuits can be altered by disease, as well as exogenous influences such as centrally-acting pharmacologics. The 'poster child' for this scenario is Parkinson's disease (PD) medically managed by pharmacological treatments. PD is a progressive neurodegenerative disease that involves a gradual loss of dopaminergic neurons largely within nigrostriatal projections. Replacement therapy includes dopamine receptor agonists that directly activate postsynaptic dopamine receptors (bypassing the requirement for functioning presynaptic terminals). Some clinically useful dopamine agonists, e.g., pramipexole and ropinirole, exhibit high affinity for the D2/D3 receptor subtypes. These agonists provide excellent relief from PD motor symptoms, but some patients exhibit debilitating ICSD. Teasing out the neuropsychiatric contribution of PD-associated pathology from the drugs used to treat PD motor symptoms is challenging. In this review, we posit that modern clinical and preclinical research converge on the conclusion that dopamine replacement therapy can mediate addictions in PD and other neurological disorders. We provide five categories of evidences that align with this position: (i) ICSD prevalence is greater with D2/D3 receptor agonist therapy vs PD alone. (ii) Capacity of dopamine replacement therapy to produce addiction-like behaviors is independent of disease for which the therapy is being provided. (iii) ICSD-like behaviors are recapitulated in laboratory rats with and without PD-like pathology. (iv) Behavioral pathology co-varies with drug exposure. (v) ICSD Features of ICSDs are consistent with agonist pharmacology and neuroanatomical substrates of addictions. Considering the underpinnings of ICSDs in PD should not only help therapeutic decision-making in neurological disorders, but also apprise ICSDs in general.
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Meynen G. Forensic psychiatry and neurolaw: Description, developments, and debates. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 65:101345. [PMID: 29724513 DOI: 10.1016/j.ijlp.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
Neuroscience produces a wealth of data on the relationship between brain and behavior, including criminal behavior. The research field studying the possible and actual impact of neuroscience on the law and legal practices, is called neurolaw. It is a new and rapidly developing domain of interdisciplinary research. Since forensic psychiatry has to do with both neuroscience and the law, neurolaw is of specific relevance for this psychiatric specialty. In this contribution, I will discuss three main research areas in neurolaw - revision, assessment, and intervention - and explore their relevance for forensic psychiatry. I will identify some valuable possibilities as well as some notable challenges - both technical and ethical - for forensic psychiatry regarding neurolaw developments.
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Affiliation(s)
- Gerben Meynen
- Department of Criminal Law, Tilburg Law School, Tilburg University, The Netherlands; Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, The Netherlands.
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15
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Vitale C, Amboni M, Erro R, Picillo M, Pellecchia MT, Barone P, Trojano L, Santangelo G. Parkinson’s disease management and impulse control disorders: current state and future perspectives. Expert Rev Neurother 2019; 19:495-508. [DOI: 10.1080/14737175.2019.1620603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Carmine Vitale
- Department of Motor Sciences and Health, University “Parthenope”, Naples, Italy
| | - Marianna Amboni
- Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Roberto Erro
- Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Marina Picillo
- Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Maria Teresa Pellecchia
- Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Paolo Barone
- Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Luigi Trojano
- Department of Psychology, University “Luigi Vanvitelli”, Caserta, Italy
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16
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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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17
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Seppi K, Ray Chaudhuri K, Coelho M, Fox SH, Katzenschlager R, Perez Lloret S, Weintraub D, Sampaio C. Update on treatments for nonmotor symptoms of Parkinson's disease-an evidence-based medicine review. Mov Disord 2019; 34:180-198. [PMID: 30653247 PMCID: PMC6916382 DOI: 10.1002/mds.27602] [Citation(s) in RCA: 534] [Impact Index Per Article: 106.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/26/2018] [Accepted: 12/12/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To update evidence-based medicine recommendations for treating nonmotor symptoms in Parkinson's disease (PD). BACKGROUND The International Parkinson and Movement Disorder Society Evidence-Based Medicine Committee's recommendations for treatments of PD were first published in 2002, updated in 2011, and now updated again through December 31, 2016. METHODS Level I studies testing pharmacological, surgical, or nonpharmacological interventions for the treatment of nonmotor symptoms in PD were reviewed. Criteria for inclusion and quality scoring were as previously reported. The disorders covered were a range of neuropsychiatric symptoms, autonomic dysfunction, disorders of sleep and wakefulness, pain, fatigue, impaired olfaction, and ophthalmologic dysfunction. Clinical efficacy, implications for clinical practice, and safety conclusions are reported. RESULTS A total of 37 new studies qualified for review. There were no randomized controlled trials that met inclusion criteria for the treatment of anxiety disorders, rapid eye movement sleep behavior disorder, excessive sweating, impaired olfaction, or ophthalmologic dysfunction. We identified clinically useful or possibly useful interventions for the treatment of depression, apathy, impulse control and related disorders, dementia, psychosis, insomnia, daytime sleepiness, drooling, orthostatic hypotension, gastrointestinal dysfunction, urinary dysfunction, erectile dysfunction, fatigue, and pain. There were no clinically useful interventions identified to treat non-dementia-level cognitive impairment. CONCLUSIONS The evidence base for treating a range of nonmotor symptoms in PD has grown substantially in recent years. However, treatment options overall remain limited given the high prevalence and adverse impact of these disorders, so the development and testing of new treatments for nonmotor symptoms in PD remains a top priority. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Klaus Seppi
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - K. Ray Chaudhuri
- Institute of PsychiatryPsychology & Neuroscience at King's College and Parkinson Foundation International Centre of Excellence at King's College HospitalDenmark HillLondonUnited Kingdom
| | - Miguel Coelho
- Serviço de NeurologiaHospital Santa Maria Instituto de Medicina Molecular Faculdade de Medicina de LisboaLisboaPortugal
| | - Susan H. Fox
- Edmond J Safra Program in Parkinson Disease, Movement Disorder ClinicToronto Western Hospital, and the University of Toronto Department of MedicineTorontoOntarioCanada
| | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative DisordersDanube HospitalViennaAustria
| | - Santiago Perez Lloret
- Institute of Cardiology ResearchUniversity of Buenos Aires, National Research CouncilBuenos AiresArgentina
| | - Daniel Weintraub
- Departments of Psychiatry and NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Parkinson's Disease and Mental Illness ResearchEducation and Clinical Centers, Philadelphia Veterans Affairs Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Cristina Sampaio
- CHDI Management/CHDI FoundationPrincetonNJUSA
- Instituto de Medicina MolecularUniversity of LisbonLisbonPortugal
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18
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19
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Garcia-Ruiz PJ. Impulse Control Disorders and Dopamine-Related Creativity: Pathogenesis and Mechanism, Short Review, and Hypothesis. Front Neurol 2018; 9:1041. [PMID: 30574117 PMCID: PMC6291460 DOI: 10.3389/fneur.2018.01041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/19/2018] [Indexed: 11/13/2022] Open
Abstract
Impulse control disorder (ICD), including pathological gambling, hypersexuality, and compulsive shopping has been linked to antiparkinsonian medication, especially dopamine agonists. The mechanism of ICD is not completely clear, but it seems that ICD is the result of an activation of dopamine receptors, mostly D3 in the ventral striatum. Patients treated with dopamine agonists that have preferential affinity for D3 (including ropinirole and pramipexole) are much more prone to develop ICD. In addition, a genetic component is probably present, especially in young patients. Finally, environment and lifestyle may also play a role: those patients engaged in physical, social, and artistic activities are probably less likely to develop ICD compared to those patients with poor physical activity living in isolated environments.
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Affiliation(s)
- Pedro J. Garcia-Ruiz
- Movement Disorders Unit, Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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20
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Abbes M, Lhommée E, Thobois S, Klinger H, Schmitt E, Bichon A, Castrioto A, Xie J, Fraix V, Kistner A, Pélissier P, Seigneuret É, Chabardès S, Mertens P, Broussolle E, Moro E, Krack P. Subthalamic stimulation and neuropsychiatric symptoms in Parkinson's disease: results from a long-term follow-up cohort study. J Neurol Neurosurg Psychiatry 2018; 89:836-843. [PMID: 29436490 DOI: 10.1136/jnnp-2017-316373] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Reports on behavioural outcomes after subthalamic nucleus deep brain stimulation in Parkinson's disease are controversial and limited to short-term data. Long-term observation in a large cohort allows a better counselling and management. METHODS To determine whether a long-term treatment with subthalamic stimulation induces or reduces impulse control behaviours, neuropsychiatric fluctuations and apathy, 69 patients treated with subthalamic stimulation are prospectively and retrospectively assessed using Ardouin Scale of Behavior in Parkinson's Disease before and after 3-10 years of stimulation. RESULTS At a mean follow-up of 6 years, all impulse control disorders and dopaminergic addiction were significantly decreased, apart from eating behaviour and hypersexuality. Neuropsychiatric fluctuations also significantly improved (ON euphoria: 38% of the patients before surgery and 1% after surgery, P<0.01; OFF dysphoria: 39% of the patients before surgery and 10% after surgery, P<0.01). However, apathy increased (25% of the patients after surgery and 3% before, P<0.01). With the retrospective analysis, several transient episodes of depression, apathy, anxiety and impulse control disorders occurred. CONCLUSIONS Bilateral subthalamic nucleus stimulation was overall very effective in improving impulse control disorders and neuropsychiatric fluctuations in parkinsonian patients in the long term despite a counteracting frequent apathy. Transient episodes of impulse control disorders still occurred within the follow-up. These findings recommend a close follow-up in parkinsonian patients presenting with neuropsychiatric symptoms before deep brain stimulation surgery. CLINICAL TRIAL REGISTRATION NCT01705418;Post-results.
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Affiliation(s)
- Marie Abbes
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France
| | - Eugénie Lhommée
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Stéphane Thobois
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Université de Lyon, Lyon, France.,Neurologie C, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,Centre de Neurosciences Cognitives, CNRS, UMR 5229, Bron, France
| | - Hélène Klinger
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Université de Lyon, Lyon, France.,Neurologie C, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,Centre de Neurosciences Cognitives, CNRS, UMR 5229, Bron, France
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Amélie Bichon
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Anna Castrioto
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Jing Xie
- Institut du vieillissement, Hospices Civils de Lyon, Hôpital des Charpennes, Lyon, France
| | - Valérie Fraix
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Andrea Kistner
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Pierre Pélissier
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Éric Seigneuret
- Department of Neurosurgery, CHU Grenoble Alpes, Grenoble, France
| | - Stéphan Chabardès
- Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France.,Department of Neurosurgery, CHU Grenoble Alpes, Grenoble, France
| | - Patrick Mertens
- Neurochirurgie A, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France
| | - Emmanuel Broussolle
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Université de Lyon, Lyon, France.,Neurologie C, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,Centre de Neurosciences Cognitives, CNRS, UMR 5229, Bron, France
| | - Elena Moro
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Paul Krack
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France.,Department of Clinical Neuroscience, Faculty University of Geneva, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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21
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Tröster AI. Some Clinically Useful Information that Neuropsychology Provides Patients, Carepartners, Neurologists, and Neurosurgeons About Deep Brain Stimulation for Parkinson's Disease. Arch Clin Neuropsychol 2018; 32:810-828. [PMID: 29077802 PMCID: PMC5860398 DOI: 10.1093/arclin/acx090] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/06/2017] [Indexed: 12/02/2022] Open
Abstract
Deep brain stimulation (DBS) is an effective (but non-curative) treatment for some of the motor symptoms and treatment complications associated with dopaminergic agents in Parkinson's disease (PD). DBS can be done relatively safely and is associated with quality of life gains. In most DBS centers, neuropsychological evaluations are performed routinely before surgery, and sometimes after surgery. The purpose of such evaluation is not to decide solely on its results whether or not to offer DBS to a given candidate, but to provide the patient and treatment team with the best available information to make reasonable risk-benefit assessments. This review provides information relevant to the questions often asked by patients and their carepartners, neurologists, and neurosurgeons about neuropsychological outcomes of DBS, including neuropsychological adverse event rates, magnitude of cognitive changes, outcomes after unilateral versus bilateral surgery directed at various targets, impact of mild cognitive impairment (MCI) on outcome, factors implicated in neurobehavioral outcomes, and safety of newer interventions or techniques such as asleep surgery and current steering.
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Affiliation(s)
- Alexander I Tröster
- Department of Clinical Neuropsychology and Center for Neuromodulation, Barrow Neurological Institute, Phoenix, AZ, USA
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22
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Bina RW, Langevin JP. Closed Loop Deep Brain Stimulation for PTSD, Addiction, and Disorders of Affective Facial Interpretation: Review and Discussion of Potential Biomarkers and Stimulation Paradigms. Front Neurosci 2018; 12:300. [PMID: 29780303 PMCID: PMC5945819 DOI: 10.3389/fnins.2018.00300] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/18/2018] [Indexed: 01/06/2023] Open
Abstract
The treatment of psychiatric diseases with Deep Brain Stimulation (DBS) is becoming more of a reality as studies proliferate the indications and targets for therapies. Opinions on the initial failures of DBS trials for some psychiatric diseases point to a certain lack of finesse in using an Open Loop DBS (OLDBS) system in these dynamic, cyclical pathologies. OLDBS delivers monomorphic input into dysfunctional brain circuits with modulation of that input via human interface at discrete time points with no interim modulation or adaptation to the changing circuit dynamics. Closed Loop DBS (CLDBS) promises dynamic, intrinsic circuit modulation based on individual physiologic biomarkers of dysfunction. Discussed here are several psychiatric diseases which may be amenable to CLDBS paradigms as the neurophysiologic dysfunction is stochastic and not static. Post-Traumatic Stress Disorder (PTSD) has several peripheral and central physiologic and neurologic changes preceding stereotyped hyper-activation behavioral responses. Biomarkers for CLDBS potentially include skin conductance changes indicating changes in the sympathetic nervous system, changes in serum and central neurotransmitter concentrations, and limbic circuit activation. Chemical dependency and addiction have been demonstrated to be improved with both ablation and DBS of the Nucleus Accumbens and as a serendipitous side effect of movement disorder treatment. Potential peripheral biomarkers are similar to those proposed for PTSD with possible use of environmental and geolocation based cues, peripheral signs of physiologic arousal, and individual changes in central circuit patterns. Non-substance addiction disorders have also been serendipitously treated in patients with OLDBS for movement disorders. As more is learned about these behavioral addictions, DBS targets and effectors will be identified. Finally, discussed is the use of facial recognition software to modulate activation of inappropriate responses for psychiatric diseases in which misinterpretation of social cues feature prominently. These include Autism Spectrum Disorder, PTSD, and Schizophrenia-all of which have a common feature of dysfunctional interpretation of facial affective clues. Technological advances and improvements in circuit-based, individual-specific, real-time adaptable modulation, forecast functional neurosurgery treatments for heretofore treatment-resistant behavioral diseases.
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Affiliation(s)
- Robert W Bina
- Division of Neurosurgery, Banner University Medical Center, Tucson, AZ, United States
| | - Jean-Phillipe Langevin
- Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
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23
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Kubu CS, Ford PJ. Clinical Ethics in the Context of Deep Brain Stimulation for Movement Disorders. Arch Clin Neuropsychol 2017; 32:829-839. [PMID: 29028865 PMCID: PMC5860076 DOI: 10.1093/arclin/acx088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/30/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Discuss common clinical ethical challenges encountered in working with patients who are candidates for deep brain stimulation (DBS) for the treatment of motor symptoms of Parkinson's disease (PD). METHOD The relevant literature is reviewed and supplemented by descriptive, ethically challenging cases stemming from decades of combined experience working on DBS teams. We outline ethical arguments and provide pragmatic recommendations to assist neuropsychologists working in movement disorder teams. RESULTS The goals of the pre-operative neuropsychological DBS assessment include: (1) identification of potential cognitive risk factors; (2) identification of relevant neuropsychiatric or neurobehavioral factors; (3) assessment of level of family support; and (4) systematic assessment of patient's and family member's goals or expectations for DBS. The information gleaned from the pre-operative neuropsychological assessment is highly relevant to the most commonly studied clinical ethics challenges encountered in DBS: (1) assessment of risk/benefit; (2) determinations regarding inclusion/exclusion; (3) autonomy; and (4) patient's perception of benefit and quality of life. CONCLUSIONS Neuropsychologists are particularly well poised to provide unique and important insights to assist with developing the most ethically sound practices that take into account patient's values as well as fiduciary responsibilities to the patient, the team, the profession, and the broader community.
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Affiliation(s)
- Cynthia S Kubu
- Center for Neurological Restoration, Cleveland Clinic, OH, USA
- Department of Bioethics, Cleveland Clinic, OH, USA
- Department of Psychiatry and Psychology, Cleveland Clinic, OH, USA
| | - Paul J Ford
- Center for Neurological Restoration, Cleveland Clinic, OH, USA
- Department of Bioethics, Cleveland Clinic, OH, USA
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