Objective: To assess frequency and outcomes of impulsivity in study participants receiving bilateral subthalamic deep brain stimulation (STN-DBS) for treatment of Parkinson’s Disease (PD) who were part of the INTREPID trial.

Background: Impulse control disorders (ICD) such as compulsive gambling, sexual, and eating behaviors are serious and increasingly recognized PD complications. The relationship between STN-DBS and ICDs has been complex and results of retrospective uncontrolled studies have revealed heterogeneous outcomes. Small retrospective studies evaluating participants before and after STN-DBS surgery have revealed potential for reduction of pre-existing behaviors, worsening, or no change.  Additionally, de novo ICDs following STN-DBS have been reported. However, there is limited knowledge about the factors and interactions accounting for these differences in outcome.

Method: INTREPID (ClinicalTrials.gov: NCT01839396) is a multi-center, prospective, double-blinded, randomized controlled trial. Participants with advanced PD were implanted bilaterally in the STN and completed a neuropsychological battery at screening (prior to DBS) and follow up (12-months). Impulsivity was examined using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease–Rating Scale  (QUIP-RS). For the QUIP-RS, scores for each compulsive behavior ranged from 0 to 16, with a higher score indicating greater severity (frequency) of symptoms. Total QUIP-RS score (ranged from 0 to 64) and ratings for each of the individual ICD behavior(s) evaluated in the QUIP-RS were analyzed. Clinically significant ICD was defined as QUIP-RS score >22.

Results: At 1-year post STN-DBS, 32 of 160 participants (20%) reported >5 point improvement in ICD scores, and 7 (4.3%) showed a >10-point improvement. Nineteen (11.8%) participants had a >5 point worsening, and 8 (5%) reported a worsening of > 10 ICD scores. Analysis of relevant demographic information, appearance of ICD and clinical factors including antiparkinsonian medications, lead location, programming settings and structural/functional connectivity will be presented.

Conclusion: This data from this prospective study suggest that at 1-year follow-up following bilateral STN-DBS, improvement or worsening in ICDs was reported.  Clinicians should be aware of these critically important issues especially when ICDs worsen or emerge post-DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impulse-control-disorders-following-bilateral-subthalamic-deep-brain-stimulation-for-parkinsons-disease-the-intrepid-randomized-controlled-trial/