Decision-making and impulse-control disorders in parkinson’s disease: Influence of dopaminergic treatment

Objective: Dopaminergic treatment is proved to ameliorate motor deficits in Parkinson’s disease (PD); however, it could have negative effects on behavior and cognition, including impulse controlling and decision-making. We aimed (1) to investigate the decision-making and impulse-control disorders (ICDs) of PD patients and their correlations with sociodemographical and clinical variables, dopaminergic treatment in particular, and (2) to determine the relation of decision-making with ICDs. Methods: The sample of 39 patients with PD and 37 healthy controls underwent cognitive tests and the task which analyzed decision-making (Iowa Gambling Task [IGT]). Besides assessing motor and nonmotor symptoms of patients with PD, ICDs were also scanned using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease. Results: Although patients with PD performed similarly to healthy controls on IGT, decision-making profile in PD related to clinical variables: dopaminergic treatment and duration of illness. In addition to this younger age of onset, higher dose of dopamine agonists, longer duration of illness, and impaired decision-making were together accounted for a substantial amount of variance in impulsive behaviors. Conclusions: Dopaminergic medication likely contributes to the impairment in decision-making, which may be the underlying mechanism of ICDs. Further studies will be necessary to understand the potential implications of this finding.Publisher's Versio

Cluster-like headache associated with vertebrobasilar dolichoectasia

Vertebrobasilar dolichoectasia (VBD) is characterized by marked elongation, dilatation, and tortuosity of the vertebral and basilar arteries. The etiology of VBD is unknown. VBD can be asymptomatic or associated with clinical manifestations, such as posterior circulation stroke, intracranial bleeding, cranial nerve disorders, brainstem compression, and obstructive hydrocephalus. However, cluster-like headache (CLH) associated with VBD has not been reported in the literature. We report a case of CLH considered as a possible manifestation of VBD

Episodic paroxysmal hemicrania with an atypical clinical presentation: a case report and review of the literature

Paroxysmal hemicrania (PH) is characterized by frequent, short-lasting, severe, unilateral headaches that occur in association with cranial autonomic features. The hallmarks of this syndrome are relatively short attacks and a complete therapeutic response to indomethacin. Although PH has been classified as strictly unilateral headache in association with cranial autonomic features, a few cases have been reported that suggest bilateral PH. We report a case of PH with bilateral distribution and bilateral autonomic features. PH may actually represent a clinical spectrum including different phenotypes

Dopamine dysregulation syndrome after pallidotomy ın a parkinson patient: A case report

Dopamin disregülasyon sendromu (DDS), Parkinson hastalarında görülen, uzun dönem dopamin replasman tedavisinin (DRT) nadir bir komplikasyonudur. DDS gelişen hastalar, motor semptomlarını kontrol altına almak için gerekenden daha fazla miktarda dopaminerjik ilacı kompulsif olarak kullanmaktadırlar. DDS’nun, subtalamik nükleus veya globus pallidus internusa yönelik nörostimülasyon ameliyatları sonrasında da ortaya çıkabileceği literatürde belirtilmiş- tir. Bu sunumda pallidotomi sonrası DDS gelişen olguyu tartıştık.Dopamine dysregulation syndrome (DDS), is a rare complication of long-term dopamine replacement therapy (DRT) in Parkinson Disease. Patients who developed DDS, require higher amounts of dopaminergic drugs than usual to control motor symptoms. Dopamine dysregulation syndrome may appear after deep brain stimulation of the subthalamic nucleus or globus pallidus internus, listed in the literature. In this report we discussed a case of DDS after pallidotomy