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Roberto Cilia, MD; Chiara Siri, PsyD; Giorgio Marotta, MD; Ioannis U. Isaias, MD; Danilo De Gaspari, PsyD; Margherita Canesi, MD; Gianni Pezzoli, MD; Angelo Antonini, MD

Arch Neurol. 2008;65(12):1604-1611.

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.

Author Affiliations: Parkinson Institute, Istituti Clinici di Perfezionamento, Milan (Drs Cilia, Siri, Isaias, Canesi, Pezzoli, Antonini, and De Gaspari); Department of Neurology, University of Milan-Bicocca, San Gerardo Hospital, Monza (Drs Cilia and Isaias); and Nuclear Medicine, IRCCS-Ospedale Maggiore, Milan (Dr Marotta), Italy.

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