Pathological gambling from dopamine agonist and deep brain stimulation of the nucleus tegmenti pedunculopontine

BMJ Case Rep. 2010 Nov 18:2010:bcr0220102774. doi: 10.1136/bcr.02.2010.2774.

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.

Publication types

  • Case Reports

MeSH terms

  • Antiparkinson Agents / adverse effects*
  • Antiparkinson Agents / therapeutic use
  • Deep Brain Stimulation / adverse effects*
  • Dopamine Agents / adverse effects*
  • Dopamine Agents / therapeutic use
  • Gambling / chemically induced
  • Gambling / etiology*
  • Humans
  • Levodopa / adverse effects*
  • Levodopa / therapeutic use
  • Male
  • Middle Aged
  • Parkinson Disease / drug therapy
  • Parkinson Disease / therapy
  • Pedunculopontine Tegmental Nucleus / physiology*

Substances

  • Antiparkinson Agents
  • Dopamine Agents
  • Levodopa