Case reportUsing STN DBS and medication reduction as a strategy to treat pathological gambling in Parkinson's disease
Introduction
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) [1], pathological gambling is an impulse-control disorder, which is part of an obsessive–compulsive clinical spectrum. This behavioral disorder has a lifetime prevalence of 1.6% in the general population [2] and is characterized by a failure to resist the impulse to gamble despite several personal and financial consequences. In the recent years, an increasing number of Parkinson's disease (PD) patients with pathological gambling have been described (for a review see [3]). This report describes two PD patients whose pathological gambling developed with increased dopaminergic therapy and resolved after subthalamic nucleus deep brain stimulation (STN-DBS) and dosage reduction.
Section snippets
Case reports
Patient No. 1: A 43-year-old man developed PD at the age of 39, with tremor of the right hand and mild rigidity of the right leg. Family and personal history was negative for psychiatric disorders. His parkinsonian symptoms, predominantly rigid-akinetic, rapidly progressed over the next 2 years. He was given ropinirole (15 mg/day) with only a minimal response. Therapy was changed to pramipexole (2.1 mg/day) and levodopa (300 mg/day)/benserazide. Levodopa and pramipexole were then increased up to
Discussion
The pathogenesis of pathological gambling is not known with certainty, but neurotransmitter disturbances, particularly dopamine, have been shown to be involved. It has recently been reported that a dysfunction in the dopaminergic mesolimbic reward system might result in gambling and other addictive behavior [4]. Although an incidental comorbidity cannot be excluded, the existence of a connection between PD and pathological gambling appears to be reasonable.
The gambling behavior of our PD
Acknowledgments
We thank Jeanne Tasker for the English review of the manuscript.
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