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December 2012; 2 (4) Clinical and Ethical Challenges

Impulse control disorders and compulsive behaviors associated with dopaminergic therapies in Parkinson disease

Howard D. Weiss, Laura Marsh
First published December 10, 2012, DOI: https://doi.org/10.1212/CPJ.0b013e318278be9b
Howard D. Weiss
Parkinson Disease Program (HDW), Sinai Hospital of Baltimore; Department of Neurology (HDW), Johns Hopkins University Medical School, Baltimore, MD; Mental Health Services (LM), Michael E. DeBakey Veterans Affairs Medical Center, Houston; and Departments of Psychiatry and Neurology (LM), Baylor College of Medicine, Houston, TX.
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Laura Marsh
Parkinson Disease Program (HDW), Sinai Hospital of Baltimore; Department of Neurology (HDW), Johns Hopkins University Medical School, Baltimore, MD; Mental Health Services (LM), Michael E. DeBakey Veterans Affairs Medical Center, Houston; and Departments of Psychiatry and Neurology (LM), Baylor College of Medicine, Houston, TX.
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Impulse control disorders and compulsive behaviors associated with dopaminergic therapies in Parkinson disease
Howard D. Weiss, Laura Marsh
Neurol Clin Pract Dec 2012, 2 (4) 267-274; DOI: 10.1212/CPJ.0b013e318278be9b

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Summary

Impulse control disorders (ICD) (most commonly pathologic gambling, hypersexuality, and uncontrollable spending) and compulsive behaviors can be triggered by dopaminergic therapies in Parkinson disease (PD). ICD are especially prevalent in patients receiving a dopamine agonist as part of their treatment regimen for PD, and have also been reported when dopamine agonists are used for other indications (e.g., restless legs syndrome). Although these iatrogenic disorders are common, affecting 1 in 7 patients with PD on dopamine agonists, they often elude detection by the treating physician. ICD lead to serious consequences, causing significant financial loss and psychosocial morbidity for many patients and families. ICD can appear at any time during treatment with dopamine agonists, sometimes within the first few months, but most often after years of treatment, particularly when patients receive dopamine agonists and levodopa together. In most cases ICD resolve if the dopamine agonist is withdrawn, and PD motor symptoms are managed with levodopa monotherapy. Familiarity with the clinical aspects, risk factors, pathophysiology, and management of ICD is essential for physicians using dopaminergic therapies to treat PD and other disorders.

  • © 2012 American Academy of Neurology
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