Influence of deep brain stimulation and dopaminergic therapy on intrinsic preference for free choice in patients with Parkinson’s disease

David Bendetowicz, Gizem Temiz, Nicolas Tempier, Elodie Hainque, Marie-Laure Welter, Virginie Czernecki, Brian Lau, Carine Karachi, Jérôme Munuera
Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. 2025-07-01; :
DOI: 10.1016/j.bpsc.2025.06.008

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https://www.bordeaux-neurocampus.fr/11883

Bendetowicz D(1), Temiz G(2), Tempier N(2), Hainque E(3), Welter ML(4),
Czernecki V(5), Lau B(2), Karachi C(6), Munuera J(7).

Author information:
(1)Sorbonne Université, Institut du Cerveau – Paris Brain Institute – ICM,
Inserm, CNRS, APHP, Paris, France; AP-HP, Hôpital de la Pitié Salpêtrière,
Neurology department, Paris, France; Current affiliation: Univ. Bordeaux, CNRS,
IMN, UMR5293, CHU Bordeaux, Service de Neurologie des Maladies
Neurodégénératives, CRMR AMS, NS-Park/FCRIN Network, Bordeaux, France.
Electronic address: .
(2)Sorbonne Université, Institut du Cerveau – Paris Brain Institute – ICM,
Inserm, CNRS, APHP, Paris, France.
(3)AP-HP, Hôpital de la Pitié Salpêtrière, Neurology department, Paris, France.
(4)Sorbonne Université, Institut du Cerveau – Paris Brain Institute – ICM,
Inserm, CNRS, APHP, Paris, France; Departement de Neurophysiology, CHU Rouen,
Université de Rouen Normandie, Rouen, France.
(5)Sorbonne Université, Institut du Cerveau – Paris Brain Institute – ICM,
Inserm, CNRS, APHP, Paris, France; AP-HP, Hôpital de la Pitié Salpêtrière,
Neurology department, Paris, France.
(6)Sorbonne Université, Institut du Cerveau – Paris Brain Institute – ICM,
Inserm, CNRS, APHP, Paris, France; AP-HP, Hôpital de la Pitié Salpêtrière,
Neurosurgery department, Paris, France.
(7)Sorbonne Université, Institut du Cerveau – Paris Brain Institute – ICM,
Inserm, CNRS, APHP, Paris, France; Institut Jean Nicod, Département d’études
cognitives, École normale supérieure, EHESS, CNRS, PSL University, Paris,
France. Electronic address: .

BACKGROUND: Humans prefer to make choices freely, even when doing so does not
maximize future outcomes, suggesting that free choice is intrinsically
rewarding. While value-based decision impairments are well documented in
Parkinson’s disease (PD), the mechanisms underlying intrinsically motivated
behavior remain unclear. This study investigates how the dopaminergic and basal
ganglia systems contribute to intrinsic reward in PD.
METHODS: We designed a decision-making task to dissociate the intrinsic value of
free choice from extrinsic reward. Twenty PD patients with subthalamic deep
brain stimulation (STN-DBS) and twenty-five on dopamine (DA) therapy completed
the task both ON and OFF treatment. Performance was compared to twenty
age-matched healthy controls. We analyzed DBS electrode contacts, modeled
activated tissue volumes, and examined cortico-subthalamic connectivity using
high-resolution diffusion MRI.
RESULTS: PD patients OFF STN-DBS showed reduced preference for free choice,
which increased when STN-DBS was ON. This effect was associated with recruitment
of the right medial prefrontal cortex (mPFC). Acute ON/OFF DA therapy did not
alter free-choice preference. However, patients with lower chronic DA
doses-comparable to those in the DBS group-exhibited reduced free-choice
preference compared to those with higher chronic intake.
CONCLUSIONS: STN-DBS enhances free-choice preference by modulating the right
mPFC-STN network, suggesting that this hyperdirect pathway influences intrinsic
valuation of choice. These results indicate that STN-DBS promotes
self-determined behavior even in risky contexts. Furthermore, chronic
dopaminergic therapy may influence sensitivity to intrinsic reward.