RT Journal Article
SR Electronic
T1 Iowa gambling task impairment in Parkinson's disease can be normalised by reduction of dopaminergic medication after subthalamic stimulation
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 186
OP 190
DO 10.1136/jnnp-2013-307146
VO 86
IS 2
A1 Castrioto, Anna
A1 Funkiewiez, Aurélie
A1 Debû, Bettina
A1 Cools, Roshan
A1 Lhommée, Eugénie
A1 Ardouin, Claire
A1 Fraix, Valérie
A1 Chabardès, Stephan
A1 Robbins, Trevor W
A1 Pollak, Pierre
A1 Krack, Paul
YR 2015
UL http://jnnp.bmj.com/content/86/2/186.abstract
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.