Objective: To study the effect of previous impulse control disorders (ICD) on subthalamic nucleus deep brain stimulation (STN-DBS) programming in subjects with Parkinson’s disease (PD).

Background: Parkinson’s disease is the most common movement disorders. Dopamine replacement therapy improves motor condition but it’s always more often complicated by ICD. STN-DBS ameliorates patient’s motor symptoms and allows reduction of the treatment. Therefore, DBS was proposed as second-line treatment for ICD in PD patients with motor complications, but does ICD influence STN-stimulation?

Methods: 174 with STN stimulation were retrospectively evaluated for presence of ICD symptoms in previous medical history, two groups were identified (ICDh+ and ICDh-). We collected motor symptoms severity (UPDRS-III), treatment dosage (calculated as levodopa equivalent daily dosage, LEDD) and stimulation paradigm; patients with suboptimal lead placement were excluded. Stimulation pattern was classified as: a) dorso-lateral (DLs) or b) ventral contacts stimulation (Vs). Groups were compared at baseline and 1-year after surgery.

Results: 1-year after surgery, stimulation pattern significantly differed across groups. DLs was more frequently selected in ICDh+ subjects than ICDh-. Vs was not tolerated in ICD+ subjects because of dyskinesia re-appearance or mood changes. Of note, ICD symptoms improved 1-year after DBS. We further confirmed an STN-DBS related amelioration of UPDRS-III score and LEDD reduction in both groups.

Conclusions: The presence of a positive medical history of ICD reduced the possibility of a ventral STN stimulation in subjects with PD. This suggests a different organization of the STN functional domains in ICD+ patients that must be taken into account during stimulation programming.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/can-a-leopard-changes-its-spots-how-impulse-control-disorder-affects-subthalamic-stimulation-paradigm/