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  • Title: Functional abnormalities underlying pathological gambling in Parkinson disease.
    Author: Cilia R, Siri C, Marotta G, Isaias IU, De Gaspari D, Canesi M, Pezzoli G, Antonini A.
    Journal: Arch Neurol; 2008 Dec; 65(12):1604-11. PubMed ID: 19064747.
    Abstract:
    BACKGROUND: Pathological gambling (PG) may develop in patients with Parkinson disease (PD) during dopamine replacement therapy, but the underlying neural correlates are still unclear. OBJECTIVE: To investigate resting state brain perfusion in PD patients with active PG compared with matched PD controls and healthy controls. DESIGN: Case-control study. SETTING: Outpatient tertiary clinic. PARTICIPANTS: Eleven right-handed PD patients with active PG according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria, 40 matched PD controls, and 29 age-matched healthy controls. INTERVENTION: All the participants underwent resting state brain perfusion single-photon emission computed tomography using technetium TC 99m ethylcysteinate dimer bicisate. All PD subjects were taking dopaminergic medication. MAIN OUTCOME MEASURE: Statistical Parametric Mapping was used for data analysis (P<.005, false discovery rate corrected). RESULTS: PD patients with PG showed resting state overactivity in a right hemisphere network that included the orbitofrontal cortex, the hippocampus, the amygdala, the insula, and the ventral pallidum. No areas of perfusion reduction were detected. CONCLUSIONS: We found that PD patients with PG have abnormal resting state dysfunction of the mesocorticolimbic network possibly associated with a drug-induced overstimulation of relatively preserved reward-related neuronal systems. These findings support the concept that PG is a "behavioral" addictive disorder.
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