Pathological gambling from dopamine agonist and deep brain stimulation of the nucleus tegmenti pedunculopontine

Management of impulse control disorders with deep brain stimulation: A double-edged sword

Deep brain stimulation (DBS) is a surgical option for advanced Parkinson's disease. Although DBS is used to treat motor fluctuation, DBS may affect non-motor symptoms including mood disorders, cognitive dysfunction, and behavior problems. Impulse control disorders (ICDs) are abnormal behaviors with various manifestations such as pathological gambling, hypersexuality, compulsive shopping, and binge eating, which can affect the quality of life in patients with Parkinson's disease. The effect of DBS on ICD is controversial. Reducing medication by DBS may improve ICDs, however, worsening or even developing new ICDs after DBS can occur. We will review the impact of DBS on ICDs and reveal factors associated with a good response to DBS as well as risk factors for developing ICDs after DBS. We also propose a strategy to manage preexisting ICD and prevent postoperative de novo ICDs.