Relationships between deep brain stimulation and impulse control disorders in Parkinson's disease, with a literature review

Abstract

Impulse control disorders (ICDs) are behavioural/neuropsychiatric complications of the pharmacological treatment of Parkinson's disease. Long term motor complications of PD can be effectively treated using deep brain stimulation (DBS) of subcortical nuclei. The relationships between ICDs and DBS treatment of the motor complications of Parkinson's disease remain unclear. We describe 50 consecutive patients in whom detailed neuropsychiatric assessments were performed as part of our routine pre-operative assessment. Eight had current or past ICDs during pre-operative assessment. These patients were more likely to be male and were younger than those without ICDs. Other psychosocial variables did not predict the presence of ICDs. Detailed neuropsychological examination failed to show any between-group differences. Our prevalence rate of 16% helps raise awareness of ICDs in this specialised clinic population and may reflect common denominators between significant motor fluctuations and dopaminergic drug - related behavioural disturbances. Four patients were deemed suitable for surgery after multi-disciplinary assessment. One had re-emergence of his ICD 18 months post-operatively, the ICD having resolved in the first 18 months. We also review published literature and the evidence regarding post-operative outcomes. We recommend the routine pre-operative examination of patients for psychopathology and emphasize the importance of post-operative psychiatric surveillance.