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  • 1
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    Psychostimulant effect of dopaminergic treatment and addictions in Parkinson's disease
    Wiley ; 2017
    In:  Movement Disorders Vol. 32, No. 11 ( 2017-11), p. 1566-1573
    Details
    In: Movement Disorders, Wiley, Vol. 32, No. 11 ( 2017-11), p. 1566-1573
    Abstract: Background : Dopamine replacement therapy in PD has been associated with both behavioral addictions and dopamine addiction. Objectives : To investigate potential association between l ‐dopa induced neuropsychiatric fluctuations and addictions in PD. Methods : A cohort of 102 patients with PD suffering from motor complications of l ‐dopa treatment was prospectively analyzed. We evaluated dopamine addiction, behavioral addictions, and neuropsychiatric fluctuations using the Ardouin scale of behavior in PD. Results : Patients with (n = 51) or without (n = 51) neuropsychiatric fluctuations did not differ in age, disease duration, medication, or UPDRS III motor score during on and off drug condition. Patients with neuropsychiatric fluctuations had a higher H & Y stage in off ‐drug condition. A multivariate model showed that dopamine addiction (odds ratio: 8.9; P  = 0.02) and behavioral addictions (odds ratio: 3.76; P  = 0.033) were more frequent in the presence of neuropsychiatric fluctuations. Behavioral addictions and dopamine addiction were more frequent in the presence than in the absence of on ‐drug euphoria (46% vs. 13.9%; P   〈  0.001 and 27% vs 6.2 %; P  = 0.003), while conversely, no association emerged between dopamine or behavioral addictions and presence of off ‐drug dysphoria. Patients with neuropsychiatric fluctuations had a poorer quality of life and a more frequent history of anxiety disorder. Conclusions : The psychostimulant effects of dopamine treatment during on ‐drug euphoria, rather than avoidance of off ‐drug dysphoria, appear to drive both behavioral addictions and abuse of medication. © 2017 International Parkinson and Movement Disorder Society
    Type of Medium: Online Resource
    ISSN: 0885-3185 , 1531-8257
    URL: Issue
    URL: Article
    DOI: 10.1002/mds.v32.11
    DOI: 10.1002/mds.27101
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2041249-6
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  • 2
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    Personality, dopamine, and Parkinson's disease: Insights from subthalamic stimulation
    Wiley ; 2017
    In:  Movement Disorders Vol. 32, No. 8 ( 2017-08), p. 1191-1200
    Details
    In: Movement Disorders, Wiley, Vol. 32, No. 8 ( 2017-08), p. 1191-1200
    Abstract: Background : Subthalamic stimulation improves the motor and neuropsychiatric symptoms of Parkinson's disease. However, the impact of this treatment on impulse control and personality is the subject of heavy debate. The objective of this study was to investigate personality changes after subthalamic stimulation. Methods : Using Cloninger's biosocial model, we assessed personality in 73 Parkinson's disease patients before and 12 months after subthalamic stimulation accompanied by a drastic reduction in dopaminergic medication. Changes in psychobehavioral symptoms were measured using a battery of validated clinical scales (apathy, depression, anxiety, hyperemotionality, mania, psychosis, punding, and impulse control behaviors). Results : One year after surgery, the harm avoidance personality domain total score increased compared with the baseline (+2.8; 34 patients; P   〈  0.001), as did 3 of its 4 subdomains: anticipatory worry (+0.7; 10 patients; P  = 0.005), shyness (+0.6; 7 patients; P  = 0.03), and fatigability (+1.1; 10 patients; P  = 0.0014). Evolution of the shyness personality trait correlated with the decrease in dopaminergic medication. Total scores in the other personality domains remained unchanged, except for extravagance, a subdomain of novelty seeking, and persistence, a subdomain of reward dependence, which both decreased following surgery (‐0.3; 7 patients; and ‐0.6; 9 patients; P  = 0.03 and P  = 0.0019, respectively). Although apathy increased, other psychobehavioral symptoms, including impulse control behaviors and neuropsychiatric nonmotor fluctuations, improved. Depression and anhedonia remained stable. Scores in hypodopaminergia and neuropsychiatric nonmotor OFF correlated with harm avoidance. Scores in hyperdopaminergia and neuropsychiatric nonmotor ON correlated with novelty seeking. Conclusions : When subthalamic stimulation is applied in Parkinson's disease, significant changes in personality traits are observed, which may be related to postoperative tapering of dopaminergic treatment. © 2017 International Parkinson and Movement Disorder Society
    Type of Medium: Online Resource
    ISSN: 0885-3185 , 1531-8257
    URL: Issue
    URL: Article
    DOI: 10.1002/mds.v32.8
    DOI: 10.1002/mds.27065
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2041249-6
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  • 3
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    Long‐term independence and quality of life after subthalamic stimulation in Parkinson disease
    Wiley ; 2022
    In:  European Journal of Neurology Vol. 29, No. 9 ( 2022-09), p. 2645-2653
    Details
    In: European Journal of Neurology, Wiley, Vol. 29, No. 9 ( 2022-09), p. 2645-2653
    Abstract: Studies on long‐term nonmotor outcomes of subthalamic nucleus stimulation in Parkinson disease (PD) are scarce. This study reports on very long‐term non‐motor and motor outcomes in one of the largest cohorts of people with advanced PD, treated for 〉 10 years with subthalamic nucleus stimulation. The main outcome was to document the evolution of independence in activities of daily living. The secondary outcomes were to measure the change in quality of life, as well as non‐motor and motor outcomes. Methods Patients were studied preoperatively, at 1 year, and beyond 10 years after subthalamic stimulation with an established protocol including motor, non‐motor, and neuropsychological assessments. Results Eighty‐five people with PD were included. Independence scores in the off‐medication condition (measured with the Schwab & England Activities of Daily Living Scale) as well as quality of life (measured with the Parkinson's Disease Questionnaire [PDQ]‐37) remained improved at longest follow‐up compared to preoperatively (respectively, p   〈  0.001, p  = 0.015). Cognitive scores, measured with the Mattis Dementia Rating Scale, significantly worsened compared to before and 1 year after surgery ( p   〈  0.001), without significant change in depression, measured with the Beck Depression Inventory. Motor fluctuations, dyskinesias, and off dystonia remained improved at longest follow‐up ( p   〈  0.001), with a significant reduction in dopaminergic treatment (45%, p   〈  0.001). Conclusions This study highlights the long‐term improvement of subthalamic stimulation on independence and quality of life, despite the progression of disease and the occurrence of levodopa‐resistant symptoms.
    Type of Medium: Online Resource
    ISSN: 1351-5101 , 1468-1331
    URL: Issue
    URL: Article
    DOI: 10.1111/ene.v29.9
    DOI: 10.1111/ene.15436
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2020241-6
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  • 4
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    Predictors of Long‐Term Outcome of Subthalamic Stimulation in Parkinson Disease
    Wiley ; 2021
    In:  Annals of Neurology Vol. 89, No. 3 ( 2021-03), p. 587-597
    Details
    In: Annals of Neurology, Wiley, Vol. 89, No. 3 ( 2021-03), p. 587-597
    Abstract: This study was undertaken to identify preoperative predictive factors of long‐term motor outcome in a large cohort of consecutive Parkinson disease (PD) patients with bilateral subthalamic nucleus deep brain stimulation (STN‐DBS). Methods All consecutive PD patients who underwent bilateral STN‐DBS at the Grenoble University Hospital (France) from 1993 to 2015 were evaluated before surgery, at 1 year (short‐term), and in the long term after surgery. All available demographic variables, neuroimaging data, and clinical characteristics were collected. Preoperative predictors of long‐term motor outcome were investigated by performing survival and univariate/multivariate Cox regression analyses. Loss of motor benefit from stimulation in the long term was defined as a reduction of less than 25% in the Movement Disorder Society–sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) part III scores compared to the baseline off‐medication scores. As a secondary objective, potential predictors of short‐term motor outcome after STN‐DBS were assessed by performing univariate and multivariate linear regression analyses. Results In the long‐term analyses (mean follow‐up = 8.4 ± 6.26 years, median = 10 years, range = 1–17 years), 138 patients were included. Preoperative higher frontal score and off‐medication MDS‐UPDRS part III scores predicted a better long‐term motor response to stimulation, whereas the presence of vascular changes on neuroimaging predicted a worse motor outcome. In 357 patients with available 1‐year follow‐up, preoperative levodopa response, tremor dominant phenotype, baseline frontal score, and off‐medication MDS‐UPDRS part III scores predicted the short‐term motor outcome. Interpretation Frontal lobe dysfunction, disease severity in the off‐medication condition, and the presence of vascular changes on neuroimaging represent the main preoperative clinical predictors of long‐term motor STN‐DBS effects. ANN NEUROL 2021;89:587–597
    Type of Medium: Online Resource
    ISSN: 0364-5134 , 1531-8249
    URL: Issue
    URL: Article
    DOI: 10.1002/ana.v89.3
    DOI: 10.1002/ana.25994
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2037912-2
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