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Pathological gambling after bilateral subthalamic nucleus stimulation in Parkinson disease
  1. H M M Smeding1,
  2. A E Goudriaan2,
  3. E M J Foncke1,
  4. P R Schuurman3,
  5. J D Speelman1,
  6. B Schmand4
  1. 1Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
  3. 3Department of Neurosurgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
  1. 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

Abstract

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.

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

https://doi.org/10.1136/jnnp.2006.102061

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    Footnotes

    • Published Online First 8 January 2007

    • Competing interests: AEG receives salary support from a New Investigator grant from the National Center for Responsible Gambling, as provided by the Institute for Research on Pathological Gambling and Related Disorders (Harvard Medical School’s Division on Addictions). EMJF received a reimbursement for a lecture from Medtronic ltd. (Minneapolis). PRS received reimbursement from Medtronic Ltd for attending two conferences. JDS acts as an independent consultant for Medtronic Ltd. He has received travel grants from Medtronic Ltd.