PT  - JOURNAL ARTICLE
AU  - Anna Castrioto
AU  - Aurélie Funkiewiez
AU  - Bettina Debû
AU  - Roshan Cools
AU  - Eugénie Lhommée
AU  - Claire Ardouin
AU  - Valérie Fraix
AU  - Stephan Chabardès
AU  - Trevor W Robbins
AU  - Pierre Pollak
AU  - Paul Krack
TI  - Iowa gambling task impairment in Parkinson's disease can be normalised by reduction of dopaminergic medication after subthalamic stimulation
AID  - 10.1136/jnnp-2013-307146
DP  - 2015 Feb 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 186--190
VI  - 86
IP  - 2
4099  - http://jnnp.bmj.com/content/86/2/186.short
4100  - http://jnnp.bmj.com/content/86/2/186.full
SO  - J Neurol Neurosurg Psychiatry2015 Feb 01; 86
AB  - Background Impulse control disorders (ICD), including pathological gambling, are common in Parkinson's disease (PD) and tend to improve after subthalamic (STN) stimulation after a marked reduction of dopaminergic medication. In order to investigate the effect of STN stimulation on impulsive decision making, we used the Iowa Gambling task (IGT). Methods We investigated IGT performance in 20 patients with PD before STN surgery with and without dopaminergic treatment and in 24 age-matched controls. All patients underwent an extensive neuropsychological interview screening for behavioural disorders. Assessment in patients was repeated 3 months after surgery without dopaminergic treatment with and without stimulation. Results Chronic antiparkinsonian treatment was drastically reduced after surgery (−74%). At baseline, on high chronic dopaminergic treatment 8/20 patients with PD presented with pathological hyperdopaminergic behaviours, which had resolved in 7/8 patients 3 months after surgery on low chronic dopaminergic treatment. Preoperative performance on the IGT was significantly impaired compared to after surgery. Conclusions Dopaminergic medication likely contributes to the impairment in decision making underlying ICDs. Deep brain stimulation allows drastic reduction of dopaminergic medication and, thus, concomitant remediation of medication-induced impairment in decision making.