Rapid resolution of dopamine dysregulation syndrome (DDS) after subthalamic DBS for Parkinson disease (PD) - A case report

Objective: To describe how subthalamic deep brain stimulation (STN-DBS) and reduction in dopamine replacement therapy (DRT) allowed rapid resolution of dopamine dysregulation syndrome (DDS) with severe behavioral disorder in a patient with late stage Parkinson disease (PD). Background: DDS was recently defined as compulsive use of dopaminergic drugs, associated with severe behavioral symptoms, and impaired social functioning, Occurring in about 4% of PD patients under DRT. STN-DBS is an effective treatment for late stage PD with treatment resistant motor fluctuations, which frequently allows also to reduce DRT. Methods: A late stage PD patient referred to our center for STN-DBS, suffering from severe DDS necessitating in-ward psychiatric management, was comprehensively assessed preoperatively and postoperatively for motor, cognitive, and psychiatric status. Results: Following subthalamic DBS procedure and medication reduction, we observed a rapid and dramatic resolution of DDS and associated psychiatric symptoms, allowing discharge from a 2-year stay in a psychiatric institution. Conclusions: DDS occurring in late stage PD patients may be dramatically improved by STN-DBS, possibly in relation with the reduction of dopaminergic medication. In contrast to other psychiatric symptoms, DDS should not be considered as an obstacle to DBS procedure in late stage PD patients.