Complex repetitive behavior: punding after bilateral subthalamic nucleus stimulation in Parkinson's disease

"Punding" is the term used to describe a stereotyped motor behavior characterized by an intense fascination with repetitive purposeless movements, such as taking apart mechanical objects, handling common objects as if they were new and entertaining, constantly picking at oneself, etc. As a phenomenon with both impulsive and compulsive features, the phenomenology of punding is currently being questioned. In order to investigate the pathophysiology of this phenomenon, we screened a population of Parkinson's disease (PD) outpatients who underwent subthalamic nucleus deep brain stimulation (STN DBS). We conducted a patient-and-relative-completed survey with 24 consecutive patients in an academic outpatient care center, using a modified version of a structured interview. Patients were administered the Unified Parkinson's Disease Rating Scale (UPDRS), the Obsessive-Compulsive Inventory and the Sheehan Disability Scale. Five (20.8%) of the 24 subjects were identified as punders, including three men (60%) and two women. The punders were comparable to the non-punders in terms of clinical and demographic factors. The punder and non-punder groups only differed statistically with regard to the length of time from DBS implantation. Those findings suggest that punding might be induced by STN DBS, and its rate of occurrence in DBS population seems to be more common than previously suspected.