Rapid Communication| Volume 312, ISSUE 1-2, P191-193, January 15, 2012

Download started.


Dopamine dysregulation syndrome after deep brain stimulation of the subthalamic nucleus in Parkinson's disease

Published:August 29, 2011DOI:


      Dopamine dysregulation syndrome is a complication of the dopaminergic treatment for Parkinson's disease, probably related to sensitization of the mesolimbic dopamine system. The relationship between dopamine dysregulation syndrome and deep brain stimulation of the subthalamic nucleus remains unclear.
      We report three patients with Parkinson's disease who developed de novo dopamine dysregulation syndrome after deep brain stimulation of the subthalamic nucleus. We hypothesized that the combined effect of dopaminergic replacement therapy and deep brain stimulation on the limbic territory of the subthalamic nucleus could have precipitated the dopamine dysregulation syndrome in these patients, by inducing hyperstimulation of the mesolimbic dopamine system. The outcome of postoperative dopamine dysregulation syndrome is poor despite deep brain stimulation adjustments, attempts to reduce the dose of dopaminergic drugs and the addition of quetiapine or antidepressants.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • O'Sullivan S.S.
        • Evans A.H.
        • Lees A.J.
        Dopamine dysregulation syndrome: an overview of its epidemiology, mechanisms and management.
        CNS Drugs. 2009; 23: 157-170
        • Evans A.H.
        • Strafella A.P.
        • Weintraub D.
        • Stacy M.
        Impulsive and compulsive behaviors in Parkinson's disease.
        Mov Disord. 2009; 24: 1561-1570
        • Evans A.H.
        • Pavese N.
        • Lawrence A.D.
        • Tai Y.F.
        • Appel S.
        • Doder M.
        • et al.
        Compulsive drug use linked to sensitized ventral striatal dopamine transmission.
        Ann Neurol. 2006; 59: 852-858
        • Weaver F.M.
        • Follett K.
        • Stern M.
        • Hur K.
        • Harris C.
        • Marks Jr., W.J.
        • et al.
        CSP 468 Study Group. Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial.
        JAMA. 2009; 301: 63-73
        • Witjas T.
        • Baunez C.
        • Henry J.M.
        • Delfini M.
        • Regis J.
        • Cherif A.A.
        • et al.
        Addiction in Parkinson's disease: impact of subthalamic nucleus deep brain stimulation.
        Mov Disord. 2005; 20: 1052-1055
        • Bandini F.
        • Primavera A.
        • Pizzorno M.
        • Cocito L.
        Using STN DBS and medication reduction as a strategy to treat pathological gambling in Parkinson's disease.
        Parkinsonism Relat Disord. 2007; 13: 369-371
        • Lim S.Y.
        • O'Sullivan S.S.
        • Kotschet K.
        • Gallagher D.A.
        • Lacey C.
        • Lawrence A.D.
        • et al.
        Dopamine dysregulation syndrome, impulse control disorders and punding after deep brain stimulation surgery for Parkinson's disease.
        J Clin Neurosci. 2009; 16: 1148-1152
        • Schüpbach W.M.
        • Chastan N.
        • Welter M.L.
        • Houeto J.L.
        • Mesnage V.
        • Bonnet A.M.
        • et al.
        Stimulation of the subthalamic nucleus in Parkinson's disease:a 5 year follow up.
        J Neurol Neurosurg Psychiatry. 2005; 76: 1640-1644
        • Benarroch E.E.
        Subthalamic nucleus and its connections: anatomic substrate for the network effects of deep brain stimulation.
        Neurology. 2008; 70: 1991-1995
        • Volkman J.
        • Moro E.
        • Pahwa R.
        Basic algorithms for the programming of deep brain stimulation in Parkinson's disease.
        Mov Disord. 2006; 21: 284-289
        • Le Jeune F.
        • Péron J.
        • Grandjean D.
        • Drapier S.
        • Haegelen C.
        • Garin E.
        • et al.
        Subthalamic nucleus stimulation affects limbic and associative circuits: a PET study.
        Eur J Nucl Med Mol Imaging. 2010; 37: 1512-1520
        • Smeding H.M.
        • Goudriann A.E.
        • Foncke E.M.
        • Schuurman P.R.
        • Speelman J.D.
        • Schmand B.
        Pathological gambling after bilateral subthalamic nucleus stimulation in Parkinson disease.
        J Neurol Neurosurg Psychiatry. 2007; 78: 517-519
        • Ballanger B.
        • van Eimeren T.
        • Moro E.
        • Lozano A.M.
        • Hamani C.
        • Boulinguez P.
        • et al.
        Stimulation of the subthalamic nucleus and impulsivity: release your horses.
        Ann Neurol. 2009; 66: 817-824
        • Thobois S.
        • Ardouin C.
        • Lhommeé E.
        • Klinger H.
        • Lagrange C.
        • Xie J.
        • et al.
        Non-motor dopamine withdrawal syndrome after surgery for Parkinson's disease: predictors and underlying mesolimbic denervation.
        Brain. 2010; 133: 1111-1127
        • Funkiewiez A.
        • Ardouin C.
        • Krack P.
        • Fraix V.
        • Van Blercom N.
        • Xie J.
        • et al.
        Acute psychotropic effects of bilateral subthalamic nucleus stimulation and levodopa in Parkinson's disease.
        Mov Disord. 2003; 18: 524-530
        • Rodriguez-Oroz M.C.
        • Jahanshahi M.
        • Krack P.
        • Litvan I.
        • Macias R.
        • Bezard E.
        • et al.
        Initial clinical manifestations of Parkinson's disease: features and pathophysiological mechanisms.
        Lancet Neurol. 2009; 8: 1128-1139
        • Ambroggi F.
        • Ishikawa A.
        • Fields H.L.
        • Nicola S.M.
        Basolateral amygdala neurons facilitate reward-seeking behaviour by exciting nucleus accumbens neurons.
        Neuron. 2008; 59: 648-661
        • Evans A.H.
        • Lawrence A.D.
        • Cresswell S.A.
        • Katzenschlager R.
        • Lees A.J.
        Compulsive use of dopaminergic drug therapy in Parkinson's disease: rewards and anti-reward.
        Mov Disord. 2010; 25: 867-876