• Shen-Yang Lim, Sean S O'Sullivan, Katya Kotschet, David A Gallagher, Cameron Lacey, Andrew D Lawrence, Andrew J Lees, Dudley J O'Sullivan, Richard F Peppard, Julian P Rodrigues, Anette Schrag, Paul Silberstein, Stephen Tisch, and Andrew H Evans.
• Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
• J Clin Neurosci. 2009 Sep 1;16(9):1148-52.

AbstractData regarding the effect of deep brain stimulation (DBS) surgery on the dopamine dysregulation syndrome (DDS), impulse control disorders (ICDs) and punding in Parkinson's disease (PD) are limited. We present a case series of 21 operated PD patients who had exhibited DDS, ICDs or punding at some stage during the disease. DDS remained unimproved or worsened post-operatively in 12/17 patients with pre-operative DDS (71%) (nine bilateral subthalamic nucleus [STN], one right-sided STN, two bilateral globus pallidus internus [GPi] DBS). DDS improved or resolved after bilateral STN DBS in 5/17 patients with pre-operative DDS. DDS apparently developed for the first time after bilateral STN DBS in two patients, although only after a latency of eight years in one case. One patient without reported pre-operative DDS or ICDs developed pathological gambling post-STN DBS. One patient had pathological gambling which resolved pre-operatively, and did not recur post-DBS. Thus, DDS, ICDs and punding may persist, worsen or develop for the first time after DBS surgery, although a minority of patients improved dramatically. Predictive factors may include physician vigilance, motor outcome and patient compliance.

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