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Ignacio Obeso

Last update Thursday 20 June 2019

Dopaminergic treatment and excessive behaviours: impulse control disorders in Parkinson disease

Ignacio Obeso

CINAC - HM Puerta del Sur, Madrid, Spain
San Pablo-CEU University, Madrid, Spain 

Patients with Parkinson´s disease (PD) may develop impulse control disorders (ICDs) under dopaminergic treatments and result in excessive behaviours. The non-motor unwanted side effects only occur in a subset of patients exposed to dopamine agonists (about 14%) or on Levodopa (7.2%), suggesting an underlying vulnerability. The wide spectrum of excessive approach tendencies towards appetitive items include primary and secondary rewards such as binge eating, hypersexuality, pathological gambling or compulsive shopping. The neurocognitive profile of ICD is marked by preference of immediate gratification and lack of adaptation to negative outcomes paralleled by enhanced signalling of the mesocortical valuation system. To date, the precise behavioural and neural changes involved in ICD are unclear. More precisely, is unclear whether ICD is a deficit of impulsive choice or impulsive actions that cannot override excessive desire of appetitive items. In my presentation, I will discuss our results that put forward the field on one specific ICD (i.e. hypersexuality) in choice behaviour (Girard, Obeso et al., 2019, Brain) and present unpublished evidence on action impulsivity (using fMRI and computational modelling). Ultimately, preliminary findings may support a transfer towards clinical consequences that will impact ICD with neuromodulation techniques. Our findings give rise to a new neurocognitive and imaging profile on one ICD subtype to open new research avenues and bridge our findings into clinical contexts.