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Brain Advance Access published online on April 3, 2009
Brain, doi:10.1093/brain/awp054
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© The Author (2009). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Increased striatal dopamine release in Parkinsonian patients with pathological gambling: a [11C] raclopride PET study

T. D. L. Steeves1,2, J. Miyasaki1, M. Zurowski3, A. E. Lang1, G. Pellecchia2, T. Van Eimeren2, P. Rusjan2, S. Houle2 and A. P. Strafella1,2,4

1 Movement Disorders Centre, Toronto Western Hospital, UHN, Ontario, Canada 2 PET Imaging Centre, Centre for Addiction and Mental Health, Ontario, Canada 3 Psychiatry Department, Toronto Western Hospital, UHN, Ontario, Canada 4 Division of Brain, Imaging and Behaviour – Systems Neuroscience, Toronto Western Research Institute, UHN, University of Toronto, Ontario, Canada

Correspondence to: Antonio P. Strafella, MD, PhD, FRCPC, Toronto Western Hospital/Institute & CAMH-PET Imaging Centre, University of Toronto, Toronto, ON, Canada E-mail: antonio.strafella{at}uhnres.utoronto.ca or antonio.strafella{at}camhpet.ca

Pathological gambling is an impulse control disorder reported in association with dopamine agonists used to treat Parkinson's disease. Although impulse control disorders are conceptualized as lying within the spectrum of addictions, little neurobiological evidence exists to support this belief. Functional imaging studies have consistently demonstrated abnormalities of dopaminergic function in patients with drug addictions, but to date no study has specifically evaluated dopaminergic function in Parkinson's disease patients with impulse control disorders. We describe results of a [11C] raclopride positron emission tomography (PET) study comparing dopaminergic function during gambling in Parkinson's disease patients, with and without pathological gambling, following dopamine agonists. Patients with pathological gambling demonstrated greater decreases in binding potential in the ventral striatum during gambling (13.9%) than control patients (8.1%), likely reflecting greater dopaminergic release. Ventral striatal bindings at baseline during control task were also lower in patients with pathological gambling. Although prior imaging studies suggest that abnormality in dopaminergic binding and dopamine release may be markers of vulnerability to addiction, this study presents the first evidence of these phenomena in pathological gambling. The emergence of pathological gambling in a number of Parkinson's disease patients may provide a model into the pathophysiology of this disorder.

Key Words: Parkinson's disease; dopamine; impulse control disorders; pathological gambling, PET, functional imaging

Abbreviations: FWHM, full width at half-maximum; ICD, impulse control disorders; LWDD, L-dopa equivalent daily dose; MAO, mono amine oxidase; PET, positron emission tomography

Received October 31, 2008. Revised January 8, 2009. Accepted February 4, 2009.


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