Long-term follow-up of impulse control disorders in Parkinson's disease.
Identifieur interne : 002492 ( PubMed/Curation ); précédent : 002491; suivant : 002493Long-term follow-up of impulse control disorders in Parkinson's disease.
Auteurs : Eugenia Mamikonyan [États-Unis] ; Andrew D. Siderowf ; John E. Duda ; Marc N. Potenza ; Stacy Horn ; Matthew B. Stern ; Daniel WeintraubSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2008.
English descriptors
- KwdEn :
- Antiparkinson Agents (therapeutic use), Drug Administration Schedule, Female, Follow-Up Studies, Gambling (psychology), Humans, Impulse Control Disorders (diagnosis), Impulse Control Disorders (epidemiology), Interview, Psychological, Male, Middle Aged, Parkinson Disease (drug therapy), Parkinson Disease (epidemiology), Parkinson Disease (psychology), Severity of Illness Index, Time Factors.
- MESH :
- chemical , therapeutic use : Antiparkinson Agents.
- diagnosis : Impulse Control Disorders.
- drug therapy : Parkinson Disease.
- epidemiology : Impulse Control Disorders, Parkinson Disease.
- psychology : Gambling, Parkinson Disease.
- Drug Administration Schedule, Female, Follow-Up Studies, Humans, Interview, Psychological, Male, Middle Aged, Severity of Illness Index, Time Factors.
Abstract
Recent studies have linked dopamine agonist (DA) usage with the development of impulse control disorders (ICDs) in Parkinson's disease (PD). Little is known about optimal management strategies or the long-term outcomes of affected patients. To report on the clinical interventions and long-term outcomes of PD patients who developed an ICD after DA initiation. Subjects contacted by telephone for a follow-up interview after a mean time period of 29.2 months. They were administered a modified Minnesota Impulse Disorder Interview for compulsive buying, gambling, and sexuality, and also self-rated changes in their ICD symptomatology. Baseline and follow-up dopamine replacement therapy use was recorded and verified by chart review. Of 18 subjects, 15 (83.3%) participated in the follow-up interview. At follow-up, patients were receiving a significantly lower DA levodopa equivalent daily dosage (LEDD) (Z = -3.1, P = 0.002) and a higher daily levodopa dosage (Z = -1.9, P = 0.05), but a similar total LEDD dosage (Z = -0.47, P = 0.64) with no changes in Unified Parkinson's Disease Rating Scale motor score (Z = -1.3, P = 0.19). As part of ICD management, 12 (80.0%) patients discontinued or significantly decreased DA treatment, all of whom experienced full or partial remission of ICD symptoms by self-report, and 10 (83.3%) of whom no longer met diagnostic criteria for an ICD. For PD patients who develop an ICD in the context of DA treatment, discontinuing or significantly decreasing DA exposure, even when offset by an increase in levodopa treatment, is associated with remission of or significant reduction in ICD behaviors without worsening in motor symptoms.
DOI: 10.1002/mds.21770
PubMed: 17960796
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<front><div type="abstract" xml:lang="en">Recent studies have linked dopamine agonist (DA) usage with the development of impulse control disorders (ICDs) in Parkinson's disease (PD). Little is known about optimal management strategies or the long-term outcomes of affected patients. To report on the clinical interventions and long-term outcomes of PD patients who developed an ICD after DA initiation. Subjects contacted by telephone for a follow-up interview after a mean time period of 29.2 months. They were administered a modified Minnesota Impulse Disorder Interview for compulsive buying, gambling, and sexuality, and also self-rated changes in their ICD symptomatology. Baseline and follow-up dopamine replacement therapy use was recorded and verified by chart review. Of 18 subjects, 15 (83.3%) participated in the follow-up interview. At follow-up, patients were receiving a significantly lower DA levodopa equivalent daily dosage (LEDD) (Z = -3.1, P = 0.002) and a higher daily levodopa dosage (Z = -1.9, P = 0.05), but a similar total LEDD dosage (Z = -0.47, P = 0.64) with no changes in Unified Parkinson's Disease Rating Scale motor score (Z = -1.3, P = 0.19). As part of ICD management, 12 (80.0%) patients discontinued or significantly decreased DA treatment, all of whom experienced full or partial remission of ICD symptoms by self-report, and 10 (83.3%) of whom no longer met diagnostic criteria for an ICD. For PD patients who develop an ICD in the context of DA treatment, discontinuing or significantly decreasing DA exposure, even when offset by an increase in levodopa treatment, is associated with remission of or significant reduction in ICD behaviors without worsening in motor symptoms.</div>
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