Objective: We present a case of severe de novo impulse control disorder (ICD) after globus pallidus internus (GPi) deep brain stimulation (DBS) in a patient with myoclonus-dystonia syndrome (MDS).
Background: In Parkinson’s Disease (PD), ICD can appear de novo after DBS of the subthalamic nucleus (STN)1. The mechanism remains unclear, but may be related to its role in mediating limbic function. De novo ICD has also been reported after GPi-DBS, where psychiatric outcomes are similar to STN-DBS2. Compared to PD, in myoclonus-dystonia syndrome a higher prevalence of obsessive-compulsive disorder, generalized anxiety disorder, depression, and alcohol abuse has been reported.
Method: Case report.
Results: Male, 32 years-old, with a clinical diagnosis of MDS, without an identified genetic mutation. Symptom onset at 8 years-old, refractory to drug therapy. When 29 years-old, he underwent GPi-DBS targeting the motor postero-ventral portion of the GPi, with an excellent motor outcome. Pre-surgical psychiatric evaluation excluded psychiatric disorders and history of previous drug use. Two months after DBS, the patient presented with pathological gambling, with severe financial consequences, and binge eating. At the time, medication was stable on clonazepam, tetrabenazine and trihexyphenidyl, with no recent changes. ICD symptoms did not respond to quetiapine, however they completely resolved after decreasing stimulation voltage. Currently, he continues to benefit from the intervention, with very good symptomatic control, while maintaining a stable personal relationship and a good professional integration.
Conclusion: The present case illustrates a severe ICD in a patient with MDS, without previous psychopathology, after motor GPi stimulation, with complete resolution after decreasing stimulation voltage. We did not find other reports of de novo ICD after DBS in this disorder. As with the STN, the GPi also plays a role in reward circuits. In the present case, medication was stable throughout the process, suggesting a mechanism involving the direct stimulation of the GPi.
References: 1. Kasemsuk C, Oyama G, Hattori N. Management of impulse control disorders with deep brain stimulation: A double-edged sword. J Neurol Sci. 2017 Mar 15;374:63-68. 2. Boel JA, Odekerken VJ, Schmand BA, Geurtsen GJ, Cath DC, Figee M, van den Munckhof P, de Haan RJ, Schuurman PR, de Bie RM; NSTAPS study group. Cognitive and psychiatric outcome 3 years after globus pallidus pars interna or subthalamic nucleus deep brain stimulation for Parkinson’s disease. Parkinsonism Relat Disord. 2016 Dec;33:90-95. 3. Justin Rossi P, Peden C, Castellanos O, Foote KD, Gunduz A, Okun MS. The human subthalamic nucleus and globus pallidus internus differentially encode reward during action control. Hum Brain Mapp. 2017 Apr;38(4):1952-1964.
To cite this abstract in AMA style:S. Parreira, L. Kauppila, M. Coelho. De novo impulse control disorder after globus pallidus internus deep brain stimulation in a patient with myoclonus-dystonia syndrome [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/de-novo-impulse-control-disorder-after-globus-pallidus-internus-deep-brain-stimulation-in-a-patient-with-myoclonus-dystonia-syndrome/. Accessed December 7, 2023.
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