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Francisco Grandas - One of the best experts on this subject based on the ideXlab platform.

Andrew J. Lees - One of the best experts on this subject based on the ideXlab platform.

  • the outcome of Dopamine Dysregulation Syndrome in parkinson s disease a retrospective postmortem study
    Movement Disorders Clinical Practice, 2018
    Co-Authors: Pedro Barbosa, Andrew J. Lees, Atbin Djamshidian, Thomas T Warner
    Abstract:

    INTRODUCTION: We have performed a retrospective analysis of the frequency and relation to treatment of Dopamine Dysregulation Syndrome (DDS) using the Queen Square Brain Bank (QSBB) database. METHODS: A search of the QSBB database for consecutive cases donated between 2005 to 2016 with a pathological diagnosis of Parkinson's disease was performed. RESULTS: DDS was present in 8.8% of cases, was more prevalent in males and associated with younger age of onset, longer disease duration and more dopa‐induced dyskinesias. Treatment approaches for DDS included: reduction of levodopa, reduction/cessation of DA and initiation of infusion therapies. DDS had completely resolved in just over half the patients. DA peak levodopa equivalent daily dose (LEDD) was higher in patients who failed to achieve remission. CONCLUSION: This is the first study to provide data on the course of DDS until death. Treatment strategies consisted mainly of reduction of Dopaminergic treatment and despite the majority of patients showing some improvement, half remained symptomatic. Successful treatment was associated with a lower l‐dopa dosage at death.

  • psychogenic and neural visual cue response in pd Dopamine Dysregulation Syndrome
    Parkinsonism & Related Disorders, 2015
    Co-Authors: Paola Piccini, Andrew J. Lees, Clare Loane, Kit Wu, Sean S Osullivan, Andrew David Lawrence, Zoe Woodhead, Marios Politis
    Abstract:

    Abstract Introduction Dopamine Dysregulation Syndrome (DDS) in Parkinson's disease (PD) patients refers to the compulsive use of Dopaminergic replacement therapy and has serious psycho-social consequences. Mechanisms underlying DDS are not clear although has been linked to dysfunctional brain reward networks. Methods With fMRI, we investigate behavioral and neural response to drug-cues in six PD DDS patients and 12 PD control patients in both the ON and OFF medication state. Behavioral measures of liking, wanting and subjectively ‘feeling ON medication’ were also collected. Results Behaviorally, PD DDS patients feel less ON and want their drugs more at baseline compared to PD controls. Following drug-cue exposure, PD DDS patients feel significantly more ON medication, which correlates with significant increases in reward related regions. Conclusions The results demonstrate that exposure to drug-cues increases the subjective feeling of being ‘ON’ medication which corresponds to dysfunctional activation in reward related regions in PD DDS patients. These findings should be extended in future studies. Visual stimuli being sufficient to elicit behavioral response through neuroadaptations could have direct implications to the management of addictive behavior.

  • Dopamine Dysregulation Syndrome impulse control disorders and punding after deep brain stimulation surgery for parkinson s disease
    Journal of Clinical Neuroscience, 2009
    Co-Authors: Shenyang Lim, Andrew J. Lees, Sean S Osullivan, David A Gallagher, Katya Kotschet, Cameron Lacey, Andrew D Lawrence, D J Osullivan, Richard F Peppard, Julian P Rodrigues
    Abstract:

    Data regarding the effect of deep brain stimulation (DBS) surgery on the Dopamine Dysregulation Syndrome (DDS), impulse control disorders (ICDs) and punding in Parkinson’s disease (PD) are limited. We present a case series of 21 operated PD patients who had exhibited DDS, ICDs or punding at some stage during the disease. DDS remained unimproved or worsened post-operatively in 12/17 patients with pre-operative DDS (71%) (nine bilateral subthalamic nucleus [STN], one right-sided STN, two bilateral globus pallidus internus [GPi] DBS). DDS improved or resolved after bilateral STN DBS in 5/17 patients with pre-operative DDS. DDS apparently developed for the first time after bilateral STN DBS in two patients, although only after a latency of eight years in one case. One patient without reported pre-operative DDS or ICDs developed pathological gambling post-STN DBS. One patient had pathological gambling which resolved pre-operatively, and did not recur post-DBS. Thus, DDS, ICDs and punding may persist, worsen or develop for the first time after DBS surgery, although a minority of patients improved dramatically. Predictive factors may include physician vigilance, motor outcome and patient compliance.

  • Dopamine Dysregulation Syndrome an overview of its epidemiology mechanisms and management
    CNS Drugs, 2009
    Co-Authors: Sean S Osullivan, Andrew Evans, Andrew J. Lees
    Abstract:

    Dopamine Dysregulation Syndrome (DDS) is a relatively recently described iatrogenic disturbance that may complicate long-term symptomatic therapy of Parkinson’s disease. Patients with DDS develop an addictive pattern of Dopamine replacement therapy (DRT) use, administering doses in excess of those required to control their motor symptoms. The prevalence of DDS in patients attending specialist Parkinson’s disease centres is 3–4%. Amongst the behavioural disturbances associated with DDS are punding, which is a complex stereotyped behaviour, and impulse control disorders (ICDs), such as pathological gambling, hypersexuality, compulsive shopping and compulsive eating.

  • pathological gambling in parkinson s disease risk factors and differences from Dopamine Dysregulation an analysis of published case series
    Movement Disorders, 2007
    Co-Authors: David A Gallagher, Andrew J. Lees, Sean S Osullivan, Andrew Evans, Anette Schrag
    Abstract:

    Pathological gambling (PG) has been reported as a complication of the treatment of Parkinson's disease (PD). We examined all published cases of PG for prevalence and risk factors of this complication, the relationship of PG and use of Dopamine agonists (DA), and the relationship of PG to the Dopamine Dysregulation Syndrome (DDS). The prevalence of PG in prospective studies of PD patients using DA has been reported between 2.3 and 8%, compared to approximately 1% in the general population. As in the general population, PD patients with this complication are often young, male and have psychiatric co-morbidity. The vast majority are on DA, often at maximum dose or above. Differences between oral DA failed to reach significance. PG associated with levodopa monotherapy is uncommon, but in the majority of cases levodopa is co-prescribed, suggesting possible cross-sensitization of brain systems mediating reward. PG can occur with DDS but often occurs in isolation. In contrast to DDS, escalation and self regulation of anti-parkinsonian medication are not usually seen. PG in patients with PD using DA is higher than PG reported in the general population, but shares similar characteristics and risk factors. PG is predominantly associated with oral DA. It often occurs in isolation and may not be associated with DDS, which typically occurs on treatment with levodopa or subcutaneous apomorphine.

Beatriz De La Casafages - One of the best experts on this subject based on the ideXlab platform.

Michael S Okun - One of the best experts on this subject based on the ideXlab platform.

  • Effects of STN and GPi Deep Brain Stimulation on Impulse Control Disorders and Dopamine Dysregulation Syndrome
    2016
    Co-Authors: Sarah J. Moum, Kelly D Foote, Catherine C. Price, Natlada Limotai, Genko Oyama, Herbert Ward, Charles Jacobson, Michael S Okun
    Abstract:

    Objective: Impulse control disorders (ICDs) and Dopamine Dysregulation Syndrome (DDS) are important behavioral problems that affect a subpopulation of patients with Parkinson’s disease (PD) and typically result in markedly diminished quality of life for patients and their caregivers. We aimed to investigate the effects of subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) on ICD/DDS frequency and Dopaminergic medication usage. Methods: A retrospective chart review was performed on 159 individuals who underwent unilateral or bilateral PD DBS surgery in either STN or GPi. According to published criteria, pre- and post-operative records were reviewed to categorize patients both pre- and post-operatively as having ICD, DDS, both ICD and DDS, or neither ICD nor DDS. Group differences in patient demographics, clinical presentations, levodopa equivalent dose (LED), and change in diagnosis following unilateral/ bilateral by brain target (STN or GPi DBS placement) were examined. Results: 28 patients met diagnostic criteria for ICD or DDS pre- or post-operatively. ICD or DDS classification did not differ by GPi or STN target stimulation. There was no change in DDS diagnosis after unilateral or bilateral stimulation. For ICD, diagnosis resolved in 2 of 7 individuals after unilateral or bilateral DBS. Post-operative development of these Syndromes wa

  • should impulse control disorders and Dopamine Dysregulation Syndrome be indications for deep brain stimulation and intestinal levodopa
    Movement Disorders, 2013
    Co-Authors: Michael S Okun, Daniel Weintraub
    Abstract:

    Among the most difficult Parkinson’s disease (PD) patients to treat are those with impulse control disorder(s) (ICD’s; compulsive gambling as well as compulsive sexual, buying and eating behaviors) or Dopamine Dysregulation Syndrome (DDS; compulsive PD medication use, particularly short-acting agents)[1, 2]. Patients are often unaware of the severity and impact of their symptoms, and can be reluctant or unable to make changes in their Dopaminergic replacement therapy (DRT), particularly Dopamine agonists (DA’s) which are most closely associated with ICD’s. Evidence in support of standard pharmacological treatments and behavioral therapy for management of these symptoms is accruing, including recent preliminary studies testing amantadine[3] and cognitive behavioral therapy[4]. Despite these recent studies, the evidence in support of non-PD pharmacologic or psychosocial treatments is very limited[2]. There has been hope that newer non-pharmacologic therapies (e.g., deep brain stimulation (DBS)) or therapies with a smoother or more constant delivery of Dopaminergic therapy (e.g., intestinal levodopa and long-acting DA’s) would offer a definitive treatment for this complex subpopulation of PD patients. However, after initial reports of improvement in ICD symptoms in most patients undergoing DBS[5, 6], recent publications have suggested a more complex association between ICD behaviors and DBS in PD. This viewpoint will review the potential basal ganglia neural mechanisms underlying these behavioral disturbances, the experience with DBS and levodopa infusions in this patient population, and the critical need for methodological rigor in future studies of this topic.

  • valproate as a treatment for Dopamine Dysregulation Syndrome dds in parkinson s disease
    Journal of Neurology, 2013
    Co-Authors: Ashok Sriram, Herbert E Ward, Anhar Hassan, Sanjay S Iyer, Kelly D Foote, Ramon L Rodriguez, Nikolaus R Mcfarland, Michael S Okun
    Abstract:

    It has been previously well established that the use of Dopaminergic agents in Parkinson's disease may contribute to behavioral disturbances such as Dopamine Dysregulation Syndrome (DDS), impulse control disorders (ICD), and punding. ICD and punding have been most commonly addressed by reducing dose or by discontinuing the use of a Dopamine agonist. Treatment of DDS has proven more challenging, and to date there has been no standard approach. In this paper, we review a series of four patients who met criteria for DDS, who were all refractory to medication adjustments. The DDS symptoms responded by the addition of valproic acid in all cases.

  • effects of stn and gpi deep brain stimulation on impulse control disorders and Dopamine Dysregulation Syndrome
    PLOS ONE, 2012
    Co-Authors: Sarah J. Moum, Herbert E Ward, Kelly D Foote, Catherine C. Price, Natlada Limotai, Genko Oyama, Charles E Jacobson, Michael S Okun
    Abstract:

    Objective Impulse control disorders (ICDs) and Dopamine Dysregulation Syndrome (DDS) are important behavioral problems that affect a subpopulation of patients with Parkinson's disease (PD) and typically result in markedly diminished quality of life for patients and their caregivers. We aimed to investigate the effects of subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) on ICD/DDS frequency and Dopaminergic medication usage. Methods A retrospective chart review was performed on 159 individuals who underwent unilateral or bilateral PD DBS surgery in either STN or GPi. According to published criteria, pre- and post-operative records were reviewed to categorize patients both pre- and post-operatively as having ICD, DDS, both ICD and DDS, or neither ICD nor DDS. Group differences in patient demographics, clinical presentations, levodopa equivalent dose (LED), and change in diagnosis following unilateral/bilateral by brain target (STN or GPi DBS placement) were examined. Results 28 patients met diagnostic criteria for ICD or DDS pre- or post-operatively. ICD or DDS classification did not differ by GPi or STN target stimulation. There was no change in DDS diagnosis after unilateral or bilateral stimulation. For ICD, diagnosis resolved in 2 of 7 individuals after unilateral or bilateral DBS. Post-operative development of these Syndromes was significant; 17 patients developed ICD diagnoses post-operatively with 2 patients with pre-operative ICD developing DDS post-operatively. Conclusions Unilateral or bilateral DBS did not significantly treat DDS or ICD in our sample, even though a few cases of ICD resolved post-operatively. Rather, our study provides preliminary evidence that DDS and ICD diagnoses may emerge following DBS surgery.

Lamy Florian - One of the best experts on this subject based on the ideXlab platform.

  • Évaluation précoce des comportements hyper-Dopaminergiques dans la maladie de Parkinson après stimulation cérébrale profonde : description et facteurs prédictifs
    'Medecine et Hygiene', 2020
    Co-Authors: Lamy Florian
    Abstract:

    Médecine. NeurologieLes troubles hyperDopaminergiques (THs) peuvent avoir de graves conséquences. Ils incluent (i) l’hypomanie, (ii) les symptômes psychotiques et (iii) les addictions comportementales (troubles du contrôle des impulsions, Syndrome de dysrégulation Dopaminergique, punding, hobbyisme). Étant donné que la plupart des études se sont concentrées sur un suivi tardif, nos objectifs étaient d’évaluer la prévalence des THs précoces (à 3 mois post-opératoire) chez les patients parkinsoniens traités par stimulation cérébrale profonde (SCP) et d'en identifier les facteurs prédictifs. Notre étude a montré que les THs peuvent s’améliorer rapidement après la SCP mais que leur survenue ne sont pas rares en post-opératoire immédiat. Les THs précoces seraient fréquents et transitoires et pourraient être expliqués par l’association de l’effet lésion, de la persistance d’une dose élevée d’agonistes Dopaminergiques et d’un effet direct de la SCP tandis que les THs tardifs seraient de mécanismes différents.HyperDopaminergic disorders (HDs) may have very serious complications. They include (i) hypomanic mood, (ii) psychotic symptoms and impulse control behaviors (ICBs) (impulse control disorders, Dopamine Dysregulation Syndrome, punding, hobbyism). Since most studies focused only on late follow up, our objectives were to explore prevalence of early (occurring during the first 3 months post-surgery) HDs in Parkinson disease patients treated by deep brain stimulation (DBS) and to identify possible predictive factors of HDs. This study demonstrates that HDs (especially ICBs) may improve early after DBS, but also that de novo HDs are not rare in the first months after surgery. Our results suggest different mechanisms between early and late post DBS HDs. Early HDs would be frequent and transient and could be explained by the association of a lesion effect, a persistent high dose of Dopamine agonist and the direct DBS effect, especially TEED rather than the location of the electrodes in the STN

  • Évaluation précoce des comportements hyper-Dopaminergiques dans la maladie de Parkinson après stimulation cérébrale profonde : description et facteurs prédictifs
    2020
    Co-Authors: Lamy Florian
    Abstract:

    Médecine. NeurologieLes troubles hyperDopaminergiques (THs) peuvent avoir de graves conséquences. Ils incluent (i) l’hypomanie, (ii) les symptômes psychotiques et (iii) les addictions comportementales (troubles du contrôle des impulsions, Syndrome de dysrégulation Dopaminergique, punding, hobbyisme). Etant donné que la plupart des études se sont concentrées sur un suivi tardif, nos objectifs étaient d’évaluer la prévalence des THs précoces (à 3 mois post-opératoire) chez les patients parkinsoniens traités par stimulation cérébrale profonde (SCP) et d'en identifier les facteurs prédictifs. Notre étude a montré que les THs peuvent s’améliorer rapidement après la SCP mais que leur survenue ne sont pas rares en post-opératoire immédiat. Les THs précoces seraient fréquents et transitoires et pourraient être expliqués par l’association de l’effet lésion, de la persistance d’une dose élevée d’agonistes Dopaminergiques et d’un effet direct de la SCP tandis que les THs tardifs seraient de mécanismes différents.HyperDopaminergic disorders (HDs) may have very serious complications. They include (i) hypomanic mood, (ii) psychotic symptoms and impulse control behaviors (ICBs) (impulse control disorders, Dopamine Dysregulation Syndrome, punding, hobbyism). Since most studies focused only on late follow up, our objectives were to explore prevalence of early (occurring during the first 3 months post-surgery) HDs in Parkinson disease patients treated by deep brain stimulation (DBS) and to identify possible predictive factors of HDs. This study demonstrates that HDs (especially ICBs) may improve early after DBS, but also that de novo HDs are not rare in the first months after surgery. Our results suggest different mechanisms between early and late post DBS HDs. Early HDs would be frequent and transient and could be explained by the association of a lesion effect, a persistent high dose of Dopamine agonist and the direct DBS effect, especially TEED rather than the location of the electrodes in the STN