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Impulsivity and Compulsivity After Subthalamic Deep Brain Stimulation for Parkinson's Disease.
Sara Scherrer1, Andrew H Smith1, Jaimie Gowatsky1
1Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Frontiers in Behavioral Neuroscience
|May 12, 2020
Summary
Subthalamic nucleus deep brain stimulation (STN DBS) for Parkinson's disease (PD) often reduces impulse-control and compulsive disorders. However, its effects on neurocognitive impulsivity are mixed, depending on stimulation location.
Area of Science:
- Neuroscience
- Neurology
- Neurosurgery
Background:
- Impulsivity and compulsivity are significant non-motor symptoms in Parkinson's disease (PD).
- The impact of subthalamic nucleus deep brain stimulation (STN DBS) on these symptoms remains debated.
- Existing research presents conflicting findings regarding STN DBS's effects on impulsivity and compulsivity in PD patients.
Purpose of the Study:
- To review the effects of STN DBS on clinical and neurocognitive aspects of impulsivity and compulsivity in Parkinson's disease.
- To synthesize current research on how STN DBS modulates behaviors related to impulse-control and compulsive disorders.
- To explore the differential impact of dorsal versus ventral STN stimulation on these non-motor symptoms.
Main Methods:
- Review of existing literature comparing pre- and post-surgical outcomes in PD patients undergoing STN DBS.
- Analysis of studies comparing "On" versus "Off" stimulation conditions to mitigate confounds like medication changes.
- Examination of neurocognitive assessments measuring behavioral flexibility, inhibitory control, and decision-making.
Main Results:
- The majority of studies show a decrease in diagnosed impulse-control and compulsive disorders post-STN DBS.
- Neurocognitive effects are more varied: STN DBS can improve behavioral flexibility without impairing key learning or control functions when targeting the dorsal STN.
- STN DBS may increase impulsive actions in choice-based scenarios and its effects on motivated responses depend on the targeted STN sub-circuits (dorsal vs. ventral).
Conclusions:
- STN DBS generally improves clinical impulsivity and compulsivity in Parkinson's disease.
- The precise neurocognitive effects are nuanced, influenced by stimulation location within the STN.
- Future research should integrate circuit-level measures with behavioral data to refine STN DBS's application for neuropsychiatric disorders.
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