Objective: To present a case of Parkinson’s disease (PD) complicated by impulse control disorder (ICD) which improved following deep brain stimulation (DBS) targeting the bilateral sub-thalamic nuclei (STN).

Background: Dopamine replacement therapy, while essential to the treatment of motor symptoms in PD, is believed to contribute to the onset of ICD, a non-motor complication which can have devastating consequences [1]. There has been considerable interest in DBS as a potential treatment for ICD, as it allows for postoperative reduction of dopaminergic medications. Literature review of DBS of STN and its association with ICD, shows a mixed picture with both good and poor outcomes. STN DBS through case reports/studies has shown resolution, improvement, worsening and even de novo ICD [2-6].

Method: Case report and review of literature

Results: A 44-year-old man with a history of PD since age 29 developed motor fluctuations requiring high doses of dopaminergic medications (up to 2,500mg of levodopa daily). He subsequently developed dopamine dysregulation syndrome, psychosis, and ICD manifested by hypersexuality, excessive spending, gambling, and binge eating.   ICD symptoms were severe and led him to drug his wife to have sexual relations, hire prostitutes, and lose close to 1 million dollars through gambling and compulsive spending. Ultimately his wife filed for divorce and filed a restraining order against him. He lost custody of his children, became homeless, and required multiple hospitalizations for stabilization of his psychosis.  Due to severe motor fluctuations he was unable to wean PD medications. He underwent placement of bilateral STN DBS and was able to reduce medications to 100mg of levodopa daily. He had significant improvement in all symptoms including ICD; his psychosis has resolved, he has returned to work, and he is rebuilding relationships with his family.

Conclusion: DBS may be an option for patients with PD complicated by motor fluctuations and severe ICD symptoms who are unable to wean dopaminergic medications.

References: 1 .Hassan A, Bower JH, Kumar N, et al. Dopamine agonist-triggered pathologiclal behaviors: surveillance in the PD clinic reveals high frequencies. Parkinsonism Relat Disord 2011;17:260-264. 2. D. Weintraub, J. Koester, M.N. Potenza, A.D. Siderowf, M. Stacy, V. Voon,J. Whetteckey, G.R. Wunderlich, A.E. Lang, Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients, Arch. Neurol. 67 (5) (2010) 589–595. 3. G. Mandybur, A.P. Duker, A.J. Espay, L. Lopiano, Impulse control behaviors and subthalamic deep brain stimulation in Parkinson disease, J. Neurol. (2016). 4. P.J. Rossi, S. De Jesus, C.W. Hess, D. Martinez-Ramirez, K.D. Foote, A. Gunduz,M.S. Okun, Measures of impulsivity in Parkinson’s disease decrease after DBS in the setting of stable dopamine therapy, Parkinsonism Relat. Disord. 44 (2017) 13–17. 5. Y.E. Kim, H.J. Kim, H.J. Kim, J.Y. Lee, J.Y. Yun, J.Y. Kim, S.H. Paek, B.S. Jeon,Impulse control and related behaviors after bilateral subthalamic stimulation in patients with Parkinson’s disease, J. Clin. Neurosci. 20 (7) (2013) 964–969. 6. S.Y. Lim, S.S. O’Sullivan, K. Kotschet, D.A. Gallagher, C. Lacey, A.D. Lawrence, A.J. Lees, D.J. O’Sullivan, R.F. Peppard, J.P. Rodrigues, A. Schrag, P. Silberstein, S. Tisch, A.H. Evans, Dopamine dysregulation syndrome, impulse control disorders and punding after deep brain stimulation surgery for Parkinson’s disease, J. Clin. Neurosci. 16 (2009), pp. 1148–1152.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/successful-treatment-of-parkinsons-disease-related-impulse-control-disorder-with-bilateral-stn-dbs/