Alterations of dopaminergic responsiveness in Parkinson’s disease: from dyskinesias to impulse control disorders

octobre 2013 Directeur(s) de thèse : Pierre-Olivier FERNAGUT Résumé de thèse

Motor impairments in Parkinson’s disease (PD) are reduced by the dopamine precursor L-Dopa and/or dopamine agonists. However, these medications elicit motor (dyskinesia) and non-motor side-effects. Up to 15% of PD patients under dopamine agonists experience behavioral addictions and withdrawal syndrome, and 3-4% of patients treated with L-Dopa or apomorphine exhibit compulsive medication intake. Both motor and non-motor complications of dopaminergic therapies involve dysfunctions in the basal ganglia network.

I explored the link between deltaFosB protein accumulation and the cellular electrical properties that trigger dyskinesia by using a cell-type specific inactivation of FosB expressing neurons of the striatum in rats and monkeys. I have also investigated in monkeys how L-Dopa modifies monoaminergic functions to mediate dyskinesia and demonstrated that limbic/cognitive structures are identically affected providing a basis for a non-motor component involved in motor side effects in PD.

From this, I studied the pathophysiology of addiction-like disorders by revealing that L-Dopa, the most widely-used treatment for PD, can acquire rewarding properties similar to cocaine in a viral-mediated rat model of PD. I also used self-administration procedures in rats to demonstrate the rewarding properties of Pramipexole, a dopamine agonist commonly use in the treatment of PD, and identified individual susceptibilities in the development of addiction-like disorders. These findings were followed by additional work showing that PD alterations modify the impulsivity trait of rats and that medication might worsen these changes.