Clinical features associated with impulse control disorders in Parkinson disease
ABSTRACT In patients with Parkinson disease (PD), impulse control disorders (ICDs) such as hypersexuality and pathologic gambling and shopping can be devastating complications of antiparkinsonian treatment. To improve their detection, we investigated clinical features associated with ICDs. Subjects were participants in a longitudinal study of PD. ICDs were associated with use of dopamine agonists and depressed mood, disinhibition, irritability, and appetite disturbance.
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ABSTRACT: High-frequency stimulation (HFS) of the subthalamic nucleus (STN) is recognized as an effective treatment for the motor symptoms of Parkinson's disease (PD), but its mechanisms, particularly as concern dopaminergic transmission, remain unclear. The aim of this study was to evaluate changes in the expression of dopaminergic receptors (D1 , D2 , and D3 receptors) after prolonged (4 h) unilateral STN-HFS in anesthetized intact rats and rats with total dopaminergic denervation. We used [(3) H]SCH 23390, [(125) I]iodosulpride, and [(125) I]OH-PIPAT to assess the densities of D1 R, D2 R, and D3 R, respectively, within different areas of the striatum-a major input structure of the basal ganglia-including the nucleus accumbens. We found that STN-HFS increased D1 R levels in almost all of the striatal areas examined, in both intact and denervated rats. By contrast, STN-HFS led to a large decrease in D2 R and D3 R levels, limited to the nucleus accumbens and independent of the dopaminergic state of the animals. These data suggest that the influence of STN-HFS on striatal D1 R expression may contribute to its therapeutic effects on motor symptoms, whereas its impact on D2 R/D3 R levels in the nucleus accumbens may account for the neuropsychiatric side effects often observed in stimulated PD patients, such as postoperative apathy. © 2015 International Parkinson and Movement Disorder Society. © 2015 International Parkinson and Movement Disorder Society.Movement Disorders 01/2015; DOI:10.1002/mds.26146 · 5.63 Impact Factor
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ABSTRACT: Impulse control disorders (ICD) in Parkinson's disease (PD) have attracted increasing interest. They are characterized by the inability to control the impulse to perform an act that can be detrimental to them or to others. Although dopamine agonists (DA), as a group, have been associated with impulse control disorders (ICD), piribedil has rarely been reported to cause them. Method: Case reports of six parkinsonian patients on piribedil presenting pathological gambling (PG). Results: All of the patients presented ICD associated with piribedil use. Two of them received this medication as first treatment and four of them who had developed ICDs secondary to other DA that reappeared with piribedil. Conclusion: Despite piribedil is commercially available in only a few countries, it should be considered in the differential diagnosis of PG in patients with PD. RESUMO Os distúrbios do controle do impulso (DCI) na doença de Parkinson (DP) têm atraído crescente interesse. Eles são caracterizados pela incapacidade da pessoa em controlar o impulso para realizar um ato que pode ser prejudicial a ela própria ou aos outros. Embora os agonistas dopaminérgicos (AD), como um grupo, têm sido associados com distúrbios do controle do impulso, o piribedil tem sido relatado raramente como causa dos mesmos. Método: Relatos de seis casos de pacientes parkinsonianos em uso de piribedil apresentando jogo patológico (JP). Resultados: Todos os pacientes apresentaram DCI com o uso do piribedil. Dois deles receberam piribedil como primeiro tratamento e quatro deles que haviam desenvolvido DCI devido a outro AD, reapresentaram o quadro com piribedil. Conclusão: Apesar de o piribedil estar disponível comercialmente apenas em alguns países, deveria ser considerado no diagnóstico diferencial de JP em pacientes com DP. Palavras-chave: distúrbios do controle do impulso, agonistas dopaminérgicos, piribedil, jogo patológico.
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ABSTRACT: Parkinson's disease (PD) is a neurodegenerative movement disorder that is characterized clinically by slowness of movement, rigidity, tremor, postural instability, and often cognitive impairments. Recent studies have demonstrated altered cortico-basal ganglia rhythms in PD, which raises the possibility of a role for non-invasive stimulation therapies such as noisy galvanic vestibular stimulation (GVS). We applied noisy GVS to 12 mild-moderately affected PD subjects (Hoehn and Yahr 1.5-2.5) off medication while they performed a sinusoidal visuomotor joystick tracking task, which alternated between 2 task conditions depending on whether the displayed cursor position underestimated the actual error by 30% ('Better') or overestimated by 200% ('Worse'). Either sham or subthreshold, noisy GVS (0.1-10 Hz, 1/f-type power spectrum) was applied in pseudorandom order. We used exploratory (linear discriminant analysis with bootstrapping) and confirmatory (robust multivariate linear regression) methods to determine if the presence of GVS significantly affected our ability to predict cursor position based on target variables. Variables related to displayed error were robustly seen to discriminate GVS in all subjects particularly in the Worse condition. If we considered higher frequency components of the cursor trajectory as "noise," the signal-to-noise ratio of cursor trajectory was significantly increased during the GVS stimulation. The results suggest that noisy GVS influenced motor performance of the PD subjects, and we speculate that they were elicited through a combination of mechanisms: enhanced cingulate activity resulting in modulation of frontal midline theta rhythms, improved signal processing in neuromotor system via stochastic facilitation and/or enhanced "vigor" known to be deficient in PD subjects. Further work is required to determine if GVS has a selective effect on corrective submovements that could not be detected by the current analyses.Frontiers in Systems Neuroscience 01/2015; 9:5. DOI:10.3389/fnsys.2015.00005