Parkinson's disease (PD) has been associated with the development of impulse control disorders (ICDs), possibly due to overstimulation of the mesolimbic system by dopaminergic medication. Preliminary reports have suggested that deep brain stimulation (DBS), a neurosurgical procedure offered to patients with treatment-resistant PD, affects ICD in a twofold way. Firstly, DBS allows a decrease in dopaminergic medication and hence causes an improvement in ICDs. Secondly, some studies have proposed that specific ICDs may develop after DBS. This paper addresses the effects of DBS on ICDs in patients with PD. A literature search identified four original studies examining a total of 182 patients for ICDs and nine case reports of 39 patients that underwent DBS and developed ICDs at some point. Data analysis from the original studies did not identify a significant difference in ICDs between patients receiving dopaminergic medication and patients on DBS, whilst the case reports showed that 56% of patients undergoing DBS had poor outcome with regards to ICDs. We discuss these ambivalent findings in the light of proposed pathogenetic mechanisms. Longitudinal, prospective studies with larger number of patients are required in order to fully understand the role of DBS on ICDs in patients with PD. 1. Introduction Parkinson’s disease (PD) is increasingly recognized as a neurodegenerative condition characterized by motor dysfunction and both physiological and psychological disturbances [1]. Although PD has been classically associated with psychiatric comorbidities such as dementia [2] and psychosis [3], recent studies have shown that patients with PD can develop a variety of behavioral problems associated with impulse dyscontrol, including pathological gambling, hypersexuality, punding (repetitive purposeless motor acts not distressing to the patient), and compulsive shopping and eating [4]. These pathological behaviors are currently classified as impulse control disorders (ICDs) and exert negative consequences in terms of the patients’ health-related quality of life, mainly because of the interference with their social functioning [5]. The aetiopathogenesis of ICDs in patients with PD is not completely understood, but previous studies showed that dopamine replacement therapy can lead to the development of ICDs due to overstimulation of the mesolimbic dopaminergic system [6] which modulates behavioral responses to reward, motivation, and reinforcement. A recent large cross-sectional study has shown that up to 13.6% of patients with treated idiopathic PD may suffer from
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