Dopamine dysregulation syndrome, impulse control disorders and punding after deep brain stimulation surgery for Parkinson's disease

J Clin Neurosci. 2009 Sep;16(9):1148-52. doi: 10.1016/j.jocn.2008.12.010. Epub 2009 Jun 23.


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.

MeSH terms

  • Adolescent
  • Adult
  • Deep Brain Stimulation / adverse effects*
  • Disruptive, Impulse Control, and Conduct Disorders / etiology*
  • Disruptive, Impulse Control, and Conduct Disorders / psychology*
  • Dopamine / metabolism
  • Dopamine / physiology*
  • Female
  • Health Care Surveys
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Movement Disorders / etiology
  • Movement Disorders / psychology
  • Neurosurgical Procedures / adverse effects*
  • Parkinson Disease / complications
  • Parkinson Disease / psychology
  • Parkinson Disease / surgery*
  • Patient Compliance
  • Postoperative Complications / psychology*
  • Surveys and Questionnaires
  • Treatment Outcome
  • Young Adult


  • Dopamine