Impulsivity and Compulsivity After Subthalamic Deep Brain Stimulation for Parkinson’s Disease
Impulsivity and compulsivity are prominent non-motor problems in Parkinson’s disease (PD). Despite 20 years of research, there is still an ongoing debate as to whether subthalamic deep brain stimulation (STN DBS) for PD exacerbates or improves these symptoms. Here, we review how STN DBS affects clin...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Frontiers Media S.A.
2020-04-01
|
Series: | Frontiers in Behavioral Neuroscience |
Subjects: | |
Online Access: | https://www.frontiersin.org/article/10.3389/fnbeh.2020.00047/full |
id |
doaj-2119907543fc4dc2bb86a0e1c865cdce |
---|---|
record_format |
Article |
spelling |
doaj-2119907543fc4dc2bb86a0e1c865cdce2020-11-25T03:01:47ZengFrontiers Media S.A.Frontiers in Behavioral Neuroscience1662-51532020-04-011410.3389/fnbeh.2020.00047511518Impulsivity and Compulsivity After Subthalamic Deep Brain Stimulation for Parkinson’s DiseaseSara ScherrerAndrew H. SmithJaimie GowatskyChristina A. PalmeseJoohi Jimenez-ShahedBrian H. KopellHelen S. MaybergMartijn FigeeImpulsivity and compulsivity are prominent non-motor problems in Parkinson’s disease (PD). Despite 20 years of research, there is still an ongoing debate as to whether subthalamic deep brain stimulation (STN DBS) for PD exacerbates or improves these symptoms. Here, we review how STN DBS affects clinical symptoms and neurocognitive aspects of impulsivity and compulsivity. When comparing patients post- to pre-surgery, in the majority of studies STN DBS for PD is associated with a decrease in clinically diagnosed impulse-control disorders and disorders of compulsivity. To avoid confounds, such as post-surgical decreases in dopaminergic medication doses, comparisons can also be made between DBS “On” versus “Off” conditions. These experimentally assayed effects of STN DBS with respect to neurocognitive aspects of impulsivity and compulsivity are more mixed. STN DBS improves behavioral flexibility without impairing negative feedback learning, delay discounting, or inhibitory control, as long as stimulation is restricted to the dorsal STN. However, STN DBS may drive impulsive actions when a subject is faced with competing choices. We discuss how motivated responses may be either enhanced or impaired by STN DBS depending on engagement of dorsal or ventral STN-mediated circuits. Future studies should combine structural and functional circuit measures with behavioral testing in PD patients on and off medication and stimulation. A more sophisticated understanding of how to modulate cortico-striatal-thalamo-cortical loops will increase the likelihood that these circuit manipulation techniques can successfully be applied to a wider range of neuropsychiatric disorders.https://www.frontiersin.org/article/10.3389/fnbeh.2020.00047/fullParkinsondeep brain stimulationsubthalamic nucleusimpulsivitycompulsivity |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sara Scherrer Andrew H. Smith Jaimie Gowatsky Christina A. Palmese Joohi Jimenez-Shahed Brian H. Kopell Helen S. Mayberg Martijn Figee |
spellingShingle |
Sara Scherrer Andrew H. Smith Jaimie Gowatsky Christina A. Palmese Joohi Jimenez-Shahed Brian H. Kopell Helen S. Mayberg Martijn Figee Impulsivity and Compulsivity After Subthalamic Deep Brain Stimulation for Parkinson’s Disease Frontiers in Behavioral Neuroscience Parkinson deep brain stimulation subthalamic nucleus impulsivity compulsivity |
author_facet |
Sara Scherrer Andrew H. Smith Jaimie Gowatsky Christina A. Palmese Joohi Jimenez-Shahed Brian H. Kopell Helen S. Mayberg Martijn Figee |
author_sort |
Sara Scherrer |
title |
Impulsivity and Compulsivity After Subthalamic Deep Brain Stimulation for Parkinson’s Disease |
title_short |
Impulsivity and Compulsivity After Subthalamic Deep Brain Stimulation for Parkinson’s Disease |
title_full |
Impulsivity and Compulsivity After Subthalamic Deep Brain Stimulation for Parkinson’s Disease |
title_fullStr |
Impulsivity and Compulsivity After Subthalamic Deep Brain Stimulation for Parkinson’s Disease |
title_full_unstemmed |
Impulsivity and Compulsivity After Subthalamic Deep Brain Stimulation for Parkinson’s Disease |
title_sort |
impulsivity and compulsivity after subthalamic deep brain stimulation for parkinson’s disease |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Behavioral Neuroscience |
issn |
1662-5153 |
publishDate |
2020-04-01 |
description |
Impulsivity and compulsivity are prominent non-motor problems in Parkinson’s disease (PD). Despite 20 years of research, there is still an ongoing debate as to whether subthalamic deep brain stimulation (STN DBS) for PD exacerbates or improves these symptoms. Here, we review how STN DBS affects clinical symptoms and neurocognitive aspects of impulsivity and compulsivity. When comparing patients post- to pre-surgery, in the majority of studies STN DBS for PD is associated with a decrease in clinically diagnosed impulse-control disorders and disorders of compulsivity. To avoid confounds, such as post-surgical decreases in dopaminergic medication doses, comparisons can also be made between DBS “On” versus “Off” conditions. These experimentally assayed effects of STN DBS with respect to neurocognitive aspects of impulsivity and compulsivity are more mixed. STN DBS improves behavioral flexibility without impairing negative feedback learning, delay discounting, or inhibitory control, as long as stimulation is restricted to the dorsal STN. However, STN DBS may drive impulsive actions when a subject is faced with competing choices. We discuss how motivated responses may be either enhanced or impaired by STN DBS depending on engagement of dorsal or ventral STN-mediated circuits. Future studies should combine structural and functional circuit measures with behavioral testing in PD patients on and off medication and stimulation. A more sophisticated understanding of how to modulate cortico-striatal-thalamo-cortical loops will increase the likelihood that these circuit manipulation techniques can successfully be applied to a wider range of neuropsychiatric disorders. |
topic |
Parkinson deep brain stimulation subthalamic nucleus impulsivity compulsivity |
url |
https://www.frontiersin.org/article/10.3389/fnbeh.2020.00047/full |
work_keys_str_mv |
AT sarascherrer impulsivityandcompulsivityaftersubthalamicdeepbrainstimulationforparkinsonsdisease AT andrewhsmith impulsivityandcompulsivityaftersubthalamicdeepbrainstimulationforparkinsonsdisease AT jaimiegowatsky impulsivityandcompulsivityaftersubthalamicdeepbrainstimulationforparkinsonsdisease AT christinaapalmese impulsivityandcompulsivityaftersubthalamicdeepbrainstimulationforparkinsonsdisease AT joohijimenezshahed impulsivityandcompulsivityaftersubthalamicdeepbrainstimulationforparkinsonsdisease AT brianhkopell impulsivityandcompulsivityaftersubthalamicdeepbrainstimulationforparkinsonsdisease AT helensmayberg impulsivityandcompulsivityaftersubthalamicdeepbrainstimulationforparkinsonsdisease AT martijnfigee impulsivityandcompulsivityaftersubthalamicdeepbrainstimulationforparkinsonsdisease |
_version_ |
1724692035331424256 |