Early hyperdopaminergic state following sub-thalamic nucleus deep brain stimulation in Parkinson disease - 22/09/22

Doi : 10.1016/j.neurol.2022.07.003

F. Lamy ^a,^b, O. Lagha-Boukbiza ^a, T. Wirth ^a, C. Philipps ^a, N. Longato ^a, O. Gebus ^a, S. Montaut ^a, A. Mengin ^c, J. Voirin ^d, F. Proust ^d, N. Tuzin ^e, M. Anheim ^a,^f,^g, C. Tranchant ^a,^f,^g,^⁎
^a Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
^b Département de neurologie fonctionnelle et d’épileptologie, hospices civils de Lyon, université de Lyon, Lyon, France
^c Clinique psychiatrique, hôpitaux universitaires de Strasbourg, 1, place de l’Hôpital, Strasbourg cedex, France
^d Service de neurochirurgie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
^e Département de santé publique, hôpitaux universitaires de Strasbourg, Strasbourg, France
^f Inserm-U964/CNRS-UMR7104, institut de génétique et de biologie moléculaire et cellulaire (IGBMC), université de Strasbourg, Illkirch, France
^g Fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, Strasbourg, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 22 September 2022
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Abstract

Background

Hyperdopaminergic state (HS), especially impulse control behaviors (ICBs), are not rare in Parkinson's disease (PD). Controversial data regarding HS prevalence one year following sub-thalamic nucleus deep brain stimulation (STN-DBS) are reported.

Objective

Our objectives were to describe early postoperative HS (PoOHS) including ICBs, hypomania and psychotic symptoms during the first 3 months following STN-DBS (V1) and their prognosis at 1 year (V2).

Methods

This descriptive study included 24 PD patients treated successively with bilateral STN-DBS between 2017 and 2019. The primary endpoint was prevalence of PoOHS at V1 according to the Ardouin Scale of Behaviour in Parkinson's Disease.

Results

Prior to STN-DBS (V0), 25% patients had HS (only ICBs) whereas at V1 (during the 3 first months), 10 patients (41.7%) had one or several HS (P=0.22) (de novo in 29.2%): 7 (29.2%) ICBs, 4 (16.7%) hypomanic mood, 1 (4.7%) psychotic symptoms. At V2, all V0 and V1 HS had disappeared, while 1 patient (4.2%) presented de novo HS (P<0.01). No correlation was found between the occurrence of PoOHS at V1 and any V0 data. Higher levodopa equivalent dose of dopamine agonists at V1 was correlated with ICB at V1 (P=0.04).

Conclusion

We found that early PoOHS are frequent in PD after STN-DBS, mostly de novo, with ICBs and hypomania being the most frequent. Despite a good prognosis of PoOHS at one year, our work emphasizes the importance of both a cautious adjustment of dopamine agonist doses and a close non-motor monitoring pre- and post-STN-DBS in PD.

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Keywords : Early hyperdopaminergic state, Impulse control behavior, Impulse control disorder, Deep brain stimulation, Hypomania, Psychotic disorder