Objective: To assess the effect of deep brain stimulation on impulse control related disorders on patients with Parkinson’s Disease (PD) at our centre.

Background: Approximately 15% of patients with Parkinson’s Disease (PD) experience issues with impulsivity and up to 13% suffer from impulse control and related disorders (ICRBs) including compulsive buying, gambling, and hypersexuality(1)(2). ICRBs have been linked to pharmaceutical treatments for PD, especially dopamine agonists, and reducing these medications has been shown to have a beneficial effect on these behaviours. Whether DBS exerts an independent effect on the presence and management of ICRBs is unclear.

Method: We reviewed clinical notes for patients who received DBS for a confirmed diagnosis of PD over a 10 year period. We established how many of these had any reference to ICRBs. Information was collected regarding duration of PD prior to DBS, estimated total levodopa dose at time of ICRB, location of DBS and course of ICRB over time.

Results: A total of 137 patients with PD were treated with DBS (bilateral STN 120/137, 88%). 37/137 (27%) had reference to ICRBs, and of these cohort, bilateral STN insertion was performed in 90% (35/37). Of the ICRBs cohort, 84% (31/37) were men, the mean age for diagnosis of PD was 46 years (y). Mean onset of ICRB following PD diagnosis was 7y in men, and 10y in women.  32/37 (86%) had ICRBs in the preoperative period, and a further 5 (14%) developed de novo ICRB following DBS treatment. Patients with de novo ICRB were found to have had PD twice as long than of those patients with pre-operative ICRB, however this failed to reach significance. 27/37 ICRB patients (75.0%) preoperatively improved with changes to the dopamine medication. 5/37 (13.5%) ICRBs either persisted or reoccurred despite treatment with DBS and changes to their medication with 13/37 (35%) suffering from more than one type of ICRB.

Conclusion: In conclusion, 73% of our ICRB cohort had a reduction in ICRBs following DBS insertion in conjunction with medication changes. However, there were no significant differences between those with de novo ICRBs and pre-existing that could be identified as possible risk factors for developing ICRB following DBS from our cohort, but this is a consideration for future research.

References: 1.Demetriades P, Rickards H, Cavanna AE. Impulse control disorders following deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: clinical aspects. Parkinsons Dis [Internet]. 2011 Feb 20;2011:658415. Available from: https://pubmed.ncbi.nlm.nih.gov/21403902 2. Weintraub D, Koester J, Potenza MN, Siderowf AD, Stacy M, Voon V, et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients. Arch Neurol. 2010 May;67(5):589–95.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effect-of-deep-brain-stimulation-on-impulse-control-related-disorders-in-parkinsons-disease-a-retrospective-review-of-137-patients/