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Journal of Neurology (1)
Journal of Neurology, Neurosurgery, and Psychiatry (1)
Barkhof, F. (1)
Berendse, H. W. (1)
Foncke, E M J (1)
Foncke, E. M. J. (1)
Goudriaan, A E (1)
Janzen, J. (1)
Lemstra, A. W. (1)
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Schuurman, P R (1)
Smeding, H M M (1)
Speelman, J D (1)
van ‘t Ent, D. (1)
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Pathological gambling after bilateral subthalamic nucleus stimulation in Parkinson disease
Smeding, H M M
Goudriaan, A E
Schuurman, P R
Speelman, J D
Journal of Neurology, Neurosurgery, and Psychiatry
We describe a patient with advanced Parkinson's disease who developed pathological gambling within a month after successful bilateral subthalamic nucleus (STN) stimulation. There was no history of gambling. On neuropsychological testing, slight cognitive decline was evident 1 year after surgery. Stimulation of the most dorsal contact with and without medication induced worse performances on decision making tests compared with the more ventral contact. Pathological gambling disappeared after discontinuation of pergolide and changing the stimulation parameters. Pathological gambling does not seem to be associated with decision making but appears to be related to a combination of bilateral STN stimulation and treatment with dopamine agonists.
The pedunculopontine nucleus is related to visual hallucinations in Parkinson’s disease: preliminary results of a voxel-based morphometry study
van ‘t Ent, D.
Lemstra, A. W.
Berendse, H. W.
Journal of Neurology
Visual hallucinations (VH) are common in Parkinson’s disease (PD) and lead to a poor quality of life. For a long time, dopaminergic therapy was considered to be the most important risk factor for the development of VH in PD. Recently, the cholinergic system, including the pedunculopontine nucleus (PPN), has been implicated in the pathophysiology of VH. The aim of the present study was to investigate grey matter density of the PPN region and one of its projection areas, the thalamus. Thirteen non-demented PD patients with VH were compared to 16 non-demented PD patients without VH, 13 demented PD patients (PDD) with VH and 11 patients with dementia with Lewy bodies (DLB). Isotropic 3-D T1-weighted MRI images (3T) were analysed using voxel-based morphometry (VBM) with the PPN region and thalamus as ROIs. PD and PDD patients with VH showed grey matter reductions of the PPN region and the thalamus compared to PD patients without VH. VH in PD(D) patients are associated with atrophy of the PPN region and its thalamic target area, suggesting that a cholinergic deficit may be involved in the development of VH in PD(D).
Voxel-based morphometry; Visual hallucinations; Parkinson’s disease; Neuroimaging
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