The Persistence of Dopamine Dysregulation Syndrome after Pallidal Deep Brain Stimulation in Parkinson's Disease

Dopamine dysregulation syndrome (DDS) is a debilitating complication of Parkinson's disease (PD) dopamine replacement therapy (DRT) in which patients pathologically and/or compulsively use dopaminergic drugs to treat motor symptoms. Studies examining DDS outcomes following deep brain stimulation (DBS) are limited and have focused on subthalamic targeting.

Here, we present DDS outcomes in six patients from the Emory Movement Disorders clinic who underwent unilateral or bilateral DBS implantation of the globus pallidus internus (GPi). Despite motor improvements and/or initial reductions in DRT dosing, all six patients continued to meet clinical criteria for DDS 6 months post-surgery, displaying persistent pathological medication use, mood disturbances, and social impairment. Anxiety surrounding levodopa use was the most persistent DDS feature following surgery.

These results indicate that pallidal DBS is not a suitable treatment for DDS and its associated symptoms.