Objective: To find effects of subthalamic deep brain stimulation on impulse control disorder in patients with Parkinson’s disease.

Background: Parkinson’s disease (PD) is a common neurodegenerative disorder, and is often associated with non-motor features, such as cognitive impairment or behavioral symptoms. We explored if STN-DBS also improves ICD, which is drug-induced non-motor complications.

Methods: Subjects: Among 69 patients with PD who received STN-DBS between March 2013 and July 2015 in Asan Medical Center, eleven from fifteen patients with ICD were selected based on Questionnaire for ICD in PD (QUIP) scores (4 or higher) before DBS. Evaluation: UPDRS III, QUIP, Addenbrooke’s cognitive examination (ACE-R) before and after DBS surgery. PET: [18F]FDG and [18F]FP-CIT PET were performed for all subjects. Regional metabolic rates were obtained from the ratio using the gray matter (GM) as reference. MRI: 3.0T MRI(pre-DBS MR 3.0T) was performed for all subjects. Data analysis: UPDRS III, QUIP and ACE-R scores were compared between pre-DBS and post-DBS stages.

Results: The eleven patients with ICD had a mean age 40.4±9.2 (mean±SD), and the mean age of PD onset was 46.6±10.7. The mean interval between the onset of parkinsonism and the onset of ICD was 4.91 ±2.77 years. The mean duration from ICD symptoms to get STN DBS operation was 3.18 ±2.99. After the STN DBS operation, the amount of L-dopa necessary was 668±314mg/day that might be decreased to a half of the amount needed before the operation. (p<0.005) Also, the QUIP score of the patients was 5.3±2.0 before STN DBS, and 1.5±1.8 after STN-DBS (p<0.005).

Conclusions: Our data showed that ICD is more common in young patients with PD, and that STN-DBS reduced LEDD markedly, to a half of pre-DBS LEDD, and provided evidence that STN-DBS improved ICD. Therefore, we can see that this DBS operation led to improvement in their quality of life. While the pathogenic mechanism of ICD is largely unknown, and seemingly different from that of motor fluctuations, our observations show that STN DBS improves both motor fluctuations and ICD. However, we must keep in mind that longitudinal, prospective studies with larger number of patients are required in order to fully understand the role of DBS on ICDs in patients with PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/improvement-of-impulse-control-disorder-in-parkinsons-disease-patients-treated-with-subthalamic-nucleus-stimulation/