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BMJ Case Rep. 2010; 2010: bcr0220102774.
Published online Nov 18, 2010. doi:  10.1136/bcr.02.2010.2774
PMCID: PMC3027559
Unexpected outcome (positive or negative) including adverse drug reactions
Pathological gambling from dopamine agonist and deep brain stimulation of the nucleus tegmenti pedunculopontine
A Stefani,1 S Galati,2 L Brusa,3 M Pierantozzi,1 A Peppe,4 and P Stanzione1
1Universitàdi Roma, Rome, Italy
2Universitàdi Roma Tor Vergata, Rome, Italy
3Osedale S.Eugenio, Rome, Italy
4Fondazione S.Lucia, Rome, Italy
Correspondence to A Stefani, stefani/at/uniroma2.it
Abstract
In patients with Parkinson's disease, aberrant or excessive dopaminergic stimulation is commonly indicated as the trigger factor in unmasking impulse control disorders (ICDs) such as pathological gambling. We had the opportunity to follow a patient who experienced Parkinson's disease 7 years ago when he was using pramipexole and again, recently, when he was treated with levodopa (L-dopa) and low frequency stimulation of the nucleus of the pedunculopontine tegmentus (PPTg) but no dopamine agonists. The same patient had shown, when studied with fluorodeoxyglucose-positron emission tomography in the condition PPTg-ON, a peculiar increased activity in the left ventral striatum. This case report confirms that, in a predisposed personality, ICD may arise from the perturbation of endogenous pathways, which connect the brainstem to the basal ganglia.
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