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Pathological gambling in Parkinson's disease: Subthalamic oscillations during economics decisions

Authors

  • Manuela Rosa MS,

    1. Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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  • Manuela Fumagalli PsyD,

    1. Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
    2. Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universitá degli Studi di Milano, Milan, Italy
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  • Gaia Giannicola MS,

    1. Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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  • Sara Marceglia MS, PhD,

    1. Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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  • Claudio Lucchiari PsyD, PhD,

    1. Dipartimento di Scienze Sociali e Politiche, Universitá degli Studi di Milano, Milan, Italy
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  • Domenico Servello MD,

    1. Neurochirurgia Funzionale e Clinica Tourette, IRCCS Galeazzi, Milan, Italy
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  • Angelo Franzini MD,

    1. Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
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  • Claudio Pacchetti MD,

    1. Unitá Operativa Parkinson e Disordini del Movimento, IRCCS Istituto Neurologico Mondino, Pavia, Italy
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  • Luigi Romito MD, PhD,

    1. Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
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  • Alberto Albanese MD,

    1. Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
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  • Mauro Porta MD,

    1. Neurochirurgia Funzionale e Clinica Tourette, IRCCS Galeazzi, Milan, Italy
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  • Gabriella Pravettoni PsyD, PhD,

    1. Dipartimento di Scienze Sociali e Politiche, Universitá degli Studi di Milano, Milan, Italy
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  • Alberto Priori MD, PhD

    Corresponding author
    1. Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
    2. Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universitá degli Studi di Milano, Milan, Italy
    • Correspondence to: Prof. A. Priori, Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; alberto.priori@unimi.it

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  • Funding agencies: The study was supported by an ERANET-Neuron Grant, Physiological Mechanisms of Deep Brain Stimulation (PhysiolDBS) (Neuron-48-013) from Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (Milan, Italy), Universitá degli Studi di Milano (Italy), Ministero della Sanitá (Italy), Ministero dell'Universitá, e della Ricerca Scientifica e Tecnologica (Italy).

  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

  • Manuela Rosa, Manuela Fumagalli, and Gaia Giannicola contributed equally to this work.

ABSTRACT

Pathological gambling develops in up to 8% of patients with Parkinson's disease. Although the pathophysiology of gambling remains unclear, several findings argue for a dysfunction in the basal ganglia circuits. To clarify the role of the subthalamic nucleus in pathological gambling, we studied its activity during economics decisions. We analyzed local field potentials recorded from deep brain stimulation electrodes in the subthalamic nucleus while parkinsonian patients with (n = 8) and without (n = 9) pathological gambling engaged in an economics decision-making task comprising conflictual trials (involving possible risk-taking) and non conflictual trials. In all parkinsonian patients, subthalamic low frequencies (2–12 Hz) increased during economics decisions. Whereas, in patients without gambling, low-frequency oscillations exhibited a similar pattern during conflictual and non conflictual stimuli, in those with gambling, low-frequency activity increased significantly more during conflictual than during non conflictual stimuli. The specific low-frequency oscillatory pattern recorded in patients with Parkinson's disease who gamble could reflect a subthalamic dysfunction that makes their decisional threshold highly sensitive to risky options. When parkinsonian patients process stimuli related to an economics task, low-frequency subthalamic activity increases. This task-related change suggests that the cognitive-affective system that drives economics decisional processes includes the subthalamic nucleus. The specific subthalamic neuronal activity during conflictual decisions in patients with pathological gambling supports the idea that the subthalamic nucleus is involved in behavioral strategies and in the pathophysiology of gambling. © 2013 International Parkinson and Movement Disorder Society

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