P0169 - Punding after bilateral subthalamic nucleus stimulation in Parkinson' disease

Abstract

“Punding” is the term used to describe a stereotypic motor behavior, in which there is an intense fascination with repetitive purposeless movements, such as taking apart mechanical objects, handling common objects as if they were new and entertaining, constantly picking at oneself.As phenomenon with features of both impulsivity and compulsivity, punding neurobiology is questioned.

evaluate the pathophysiology of punding and specifically the glutamatergic role in this phenomenon, we screened a population of Parkinson's disease (PD) patients that attended an ambulatory for subthalamic nucleus deep brain stimulation (STN DBS).

We conducted a patient-and-caregiver-completed punding survey with 24 consecutive patients using a modified version of a structured interview, the UPDRS, the Obsessive Compulsive Inventory and the Sheehan Disability Scale.

Five (20.8%) of the 24 subjects were identified as punders, three men (60%) and two women.

The punders were comparable to the nonpunders in terms of age, disease duration, hour/night sleeping, obsessive compulsive symptoms, distress, total daily dose of L-dopa equivalent units, decrement in daily L-dopa equivalent units permitted by DBS and the impact of DBS on overall “on” and “off” motor function. The punder and nonpunder groups statisticallydiffered only with regard to time-distance from DBS implantation: on average the punders started bilateral STN DBS 1.96 years before the nonpunder group.

Conclusion:

Punding, defined as a disinhibition of motor learning programs, may be induced by STN DBS, and its prevalence is much more common than previously suspected. In our sample punding was ego-syntonic, non-disruptive, “cue elicited” and characterized by low craving.