SHORT REPORT

Pathological gambling after bilateral subthalamic nucleus stimulation in Parkinson disease

H M M Smeding¹, A E Goudriaan², E M J Foncke¹, P R Schuurman³, J D Speelman¹, B Schmand⁴

¹ Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
² Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
³ Department of Neurosurgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
⁴ Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands

Correspondence to:
H M M Smeding
Department of Neurology, H2-222, Academic Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; h.m.smeding{at}amc.uva.nl

We describe a patient with advanced Parkinson’s disease who developed pathological gambling within a month after successful bilateral subthalamic nucleus (STN) stimulation. There was no history of gambling. On neuropsychological testing, slight cognitive decline was evident 1 year after surgery. Stimulation of the most dorsal contact with and without medication induced worse performances on decision making tests compared with the more ventral contact. Pathological gambling disappeared after discontinuation of pergolide and changing the stimulation parameters. Pathological gambling does not seem to be associated with decision making but appears to be related to a combination of bilateral STN stimulation and treatment with dopamine agonists.

Abbreviations: DBS, deep brain stimulation; IGT, Iowa Gambling Task; MCP, mid-commissural point; PD, Parkinson’s disease; STN, subthalamic nucleus

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