Neurophilosophy

Raymond_Mandale.jpg

A 58-year-old man from Cumbria has had electrodes implanted his brain in order to treat his compulsive gambling.

Raymond Mandale (right), who suffers from Parkinson’s, claims that his gambling habit was caused by a prescribed drug he had been taking to alleviate the symptoms of his condition, and is now seeking compensation from the manufacturers of the drug.

Mandale’s case is not unprecedented. In the past few months, several Parkinson’s patients who began gambling compulsively after taking the dopamine agonist Mirapex have brought lawsuits against the pharmaceuticals companies involved.

Dopamine agonists are associated with various other compulsive behaviours too: it is estimated that up to 14% of Parkinson’s patients who take them experience binge eating, hypersexuality or compulsive shopping or gambling as side effects.

Parkinsonian patients are increasingly being treated with deep brain stimulation (DBS), the experimental technique that was used to treat Mandale, and they, too, often begin to behave compulsively following surgery.

This occurs because Parkinson’s involves degeneration of dopamine-producing cells in a part of the brain stem called the substantia nigra. These cells normally form connections with neurons in a nearby area called the subthalamic nucleus (STN), which is now known to play an important role in decision making.

Thus, although chronic stimulation of the STN is effective in treating Parkinson’s, perturbation of the cellular activity in this part of the brain can affect the decision making process, leading to compulsive behaviour. Likewise, so too can dopamine agonists, by their actions on receptors in the STN.

Comments

  1. #1 sobriquet-defect
    April 7, 2008

    “Parkinsonian patients are increasingly being treated with deep brain stimulation (DBS), the experimental technique that was used to treat Mandale, and they, too, often begin to behave compulsively following surgery.”

    So, isn’t it a bit premature to say switching to DBS has cured him? If DBS has the same effects, couldn’t the relief from the gambling addiction just be temporary, allowing him to potentially relapse back into the addiction or some other one in the near future?

  2. #2 Romeo Vitelli
    April 7, 2008

    It took a bit of reading into the original article for me to figure out why a man who had brain surgery was showing a scar on his chest. I didn’t think my knowledge of human anatomy was that bad.

  3. #3 Richard Walker
    April 7, 2008

    “binge eating, hypersexuality or compulsive shopping or gambling as side effects.” sounds like Vegas, baby.

    srsly though, my late grandma declined DBS treatment.

  4. #4 theneurotic
    April 8, 2008

    I’m no Parkinson’s patient and am not very well read on the subject, however, it seems to me that dopamine agonists would primarily make traditionally rewarding behaviors even more rewarding and not, necessarily, have anything to do with impulsivity. Thus, if I were the pharmaceutical company, I’d argue that it was still Mr. Mandale who chose to gamble in the first place. If the label warns against Mirapex’s general effect on addiction in general I think they’d have a decent argument.

    Cheers.

  5. #5 Mo
    April 8, 2008

    Romeo – I neglected to mention that the electrodes used in DBS are controleld by a “pacemaker” that is placed under the skin in the chest.

    I’ve written about DBS in some detail quite a few times (follow my links), so I don’t want to keep repeating myself.

  6. #6 Asad
    April 10, 2008

    I wonder if DBS would ameliorate the gambling addictions of people who don’t have Parkinson’s.

  7. #7 getnutri
    April 12, 2008

    Scientists claim that the brain cells responsible for triggering Parkinson’s disease have been identified, and they now believe the discovery could lead to new ways to treat the condition. The “mother cells” which have been identified produce and use the chemical dopamine to transmit messages in the brain. The depletion of these cells and the associated lack of dopamine, causes chronic and progressive symptoms including tremors, stiff muscles and slow movement in sufferers.

  8. #8 Mo
    April 12, 2008

    getnutri – it is very well established that the symptoms of Parkinson’s Disease occur as a result of the degeneration of dopaminergic midbrain neurons.

    P.S. I deleted the link to the nutritional supplements website you are trying to advertise, because I won’t endorse such products on this site.

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    June 6, 2008

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    Sincerely,
    Kelly

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