Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic
Identifieur interne : 000E28 ( Main/Corpus ); précédent : 000E27; suivant : 000E29Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic
Auteurs : Margarita Pondal ; Connie Marras ; Janis Miyasaki ; Elena Moro ; Melissa J. Armstrong ; Antonio P. Strafella ; Binit B. Shah ; Susan Fox ; L K Prashanth ; Nicolas Phielipp ; Anthony E. LangSource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2013-02.
Abstract
Background Recently, symptoms similar to addictive drug withdrawal have been reported in a structured longitudinal study of patients with idiopathic Parkinson's Disease (PD) withdrawing from dopamine agonists (DA): the dopamine agonist withdrawal syndrome (DAWS). Objectives The objective of this study was to establish the frequency, predictors, and outcomes of DAWS in a movement disorders clinic. Methods We conducted a retrospective chart review of a sample of patients with a clinical diagnosis of PD treated with DA in whom withdrawal or attempted withdrawal of DA was carried out because of adverse effects, or for any other reason. Out of 487 PD patient charts reviewed, 84 were withdrawn from the agonists and were evaluable. Results Thirteen patients (15.5%) met criteria for DAWS (DAWS+) and 71 did not (DAWS−). DAWS developed upon withdrawal from pergolide, pramipexole and ropinirole, and did not respond to levodopa. DAWS outcomes included recovery in less than 6 months in 61%, in more than a year in 23%, and an inability to discontinue DA in 15% of patients. Development of impulse control disorders was the reason for DA withdrawal in all DAWS+, but only in 41% of DAWS− patients (p<0.0001). DAWS+ and DAWS− patients did not differ in other variables. Conclusion DAWS is a disabling complication of DA use. Critical features of the syndrome are the strong link with impulse control disorders, possibly the independence of DA dosage and type, and the resistance to treatment, including levodopa. Further studies are required to characterise those at risk as well as to define an effective treatment.
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DOI: 10.1136/jnnp-2012-302684
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Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Miyasaki, Janis" sort="Miyasaki, Janis" uniqKey="Miyasaki J" first="Janis" last="Miyasaki">Janis Miyasaki</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. 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Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E" last="Lang">Anthony E. Lang</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:1383EF35546E812F3C1739C01522FC673BDAF44B</idno><date when="2013" year="2013">2013</date><idno type="doi">10.1136/jnnp-2012-302684</idno><idno type="url">https://api.istex.fr/document/1383EF35546E812F3C1739C01522FC673BDAF44B/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">000E28</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic</title><author><name sortKey="Pondal, Margarita" sort="Pondal, Margarita" uniqKey="Pondal M" first="Margarita" last="Pondal">Margarita Pondal</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: mpondals@gmail.com</mods:affiliation></affiliation></author><author><name sortKey="Marras, Connie" sort="Marras, Connie" uniqKey="Marras C" first="Connie" last="Marras">Connie Marras</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Miyasaki, Janis" sort="Miyasaki, Janis" uniqKey="Miyasaki J" first="Janis" last="Miyasaki">Janis Miyasaki</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Armstrong, Melissa J" sort="Armstrong, Melissa J" uniqKey="Armstrong M" first="Melissa J" last="Armstrong">Melissa J. Armstrong</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Strafella, Antonio P" sort="Strafella, Antonio P" uniqKey="Strafella A" first="Antonio P" last="Strafella">Antonio P. Strafella</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Shah, Binit B" sort="Shah, Binit B" uniqKey="Shah B" first="Binit B" last="Shah">Binit B. Shah</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Fox, Susan" sort="Fox, Susan" uniqKey="Fox S" first="Susan" last="Fox">Susan Fox</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Prashanth, L K" sort="Prashanth, L K" uniqKey="Prashanth L" first="L K" last="Prashanth">L K Prashanth</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Phielipp, Nicolas" sort="Phielipp, Nicolas" uniqKey="Phielipp N" first="Nicolas" last="Phielipp">Nicolas Phielipp</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E" last="Lang">Anthony E. Lang</name><affiliation><mods:affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2013-02">2013-02</date><biblScope unit="volume">84</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="130">130</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">1383EF35546E812F3C1739C01522FC673BDAF44B</idno><idno type="DOI">10.1136/jnnp-2012-302684</idno><idno type="href">jnnp-84-130.pdf</idno><idno type="ArticleID">jnnp-2012-302684</idno><idno type="PMID">22933817</idno><idno type="Related-article-Href">10.1136/jnnp-2012-303570</idno><idno type="related-article-ID">RA1</idno><idno type="local">jnnp;84/2/130</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background Recently, symptoms similar to addictive drug withdrawal have been reported in a structured longitudinal study of patients with idiopathic Parkinson's Disease (PD) withdrawing from dopamine agonists (DA): the dopamine agonist withdrawal syndrome (DAWS). Objectives The objective of this study was to establish the frequency, predictors, and outcomes of DAWS in a movement disorders clinic. Methods We conducted a retrospective chart review of a sample of patients with a clinical diagnosis of PD treated with DA in whom withdrawal or attempted withdrawal of DA was carried out because of adverse effects, or for any other reason. Out of 487 PD patient charts reviewed, 84 were withdrawn from the agonists and were evaluable. Results Thirteen patients (15.5%) met criteria for DAWS (DAWS+) and 71 did not (DAWS−). DAWS developed upon withdrawal from pergolide, pramipexole and ropinirole, and did not respond to levodopa. DAWS outcomes included recovery in less than 6 months in 61%, in more than a year in 23%, and an inability to discontinue DA in 15% of patients. Development of impulse control disorders was the reason for DA withdrawal in all DAWS+, but only in 41% of DAWS− patients (p<0.0001). DAWS+ and DAWS− patients did not differ in other variables. Conclusion DAWS is a disabling complication of DA use. Critical features of the syndrome are the strong link with impulse control disorders, possibly the independence of DA dosage and type, and the resistance to treatment, including levodopa. Further studies are required to characterise those at risk as well as to define an effective treatment.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Margarita Pondal</name><affiliations><json:string>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</json:string><json:string>E-mail: mpondals@gmail.com</json:string></affiliations></json:item><json:item><name>Connie Marras</name><affiliations><json:string>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Janis Miyasaki</name><affiliations><json:string>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Elena Moro</name><affiliations><json:string>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Melissa J Armstrong</name><affiliations><json:string>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Antonio P Strafella</name><affiliations><json:string>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Binit B Shah</name><affiliations><json:string>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Susan Fox</name><affiliations><json:string>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>L K Prashanth</name><affiliations><json:string>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Nicolas Phielipp</name><affiliations><json:string>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Anthony E Lang</name><affiliations><json:string>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Movement disorders</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>JNNP Patients' choice</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Behavioural manifestations in Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>dopamine agonists</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>impulse control disorders</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease treatment</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>withdrawal syndrome</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Background Recently, symptoms similar to addictive drug withdrawal have been reported in a structured longitudinal study of patients with idiopathic Parkinson's Disease (PD) withdrawing from dopamine agonists (DA): the dopamine agonist withdrawal syndrome (DAWS). Objectives The objective of this study was to establish the frequency, predictors, and outcomes of DAWS in a movement disorders clinic. Methods We conducted a retrospective chart review of a sample of patients with a clinical diagnosis of PD treated with DA in whom withdrawal or attempted withdrawal of DA was carried out because of adverse effects, or for any other reason. Out of 487 PD patient charts reviewed, 84 were withdrawn from the agonists and were evaluable. Results Thirteen patients (15.5%) met criteria for DAWS (DAWS+) and 71 did not (DAWS−). DAWS developed upon withdrawal from pergolide, pramipexole and ropinirole, and did not respond to levodopa. DAWS outcomes included recovery in less than 6 months in 61%, in more than a year in 23%, and an inability to discontinue DA in 15% of patients. Development of impulse control disorders was the reason for DA withdrawal in all DAWS+, but only in 41% of DAWS− patients (p>0.0001). DAWS+ and DAWS− patients did not differ in other variables. Conclusion DAWS is a disabling complication of DA use. Critical features of the syndrome are the strong link with impulse control disorders, possibly the independence of DA dosage and type, and the resistance to treatment, including levodopa. Further studies are required to characterise those at risk as well as to define an effective treatment.</abstract><qualityIndicators><score>7.704</score><pdfVersion>1.3</pdfVersion><pdfPageSize>595.163 x 793.587 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>7</keywordCount><abstractCharCount>1616</abstractCharCount><pdfWordCount>4704</pdfWordCount><pdfCharCount>31180</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>255</abstractWordCount></qualityIndicators><title>Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic</title><pmid><json:string>22933817</json:string></pmid><genre><json:string>research-article</json:string></genre><host><volume>84</volume><pages><first>130</first></pages><issn><json:string>0022-3050</json:string></issn><issue>2</issue><genre></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-330X</json:string></eissn><title>Journal of Neurology, Neurosurgery & Psychiatry</title></host><publicationDate>2013</publicationDate><copyrightDate>2013</copyrightDate><doi><json:string>10.1136/jnnp-2012-302684</json:string></doi><id>1383EF35546E812F3C1739C01522FC673BDAF44B</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/1383EF35546E812F3C1739C01522FC673BDAF44B/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/1383EF35546E812F3C1739C01522FC673BDAF44B/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/1383EF35546E812F3C1739C01522FC673BDAF44B/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd</publisher><availability><p>BMJ</p></availability><date>2012-08-29</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic</title><author corresp="yes"><persName><forename type="first">Margarita</forename><surname>Pondal</surname></persName><email>mpondals@gmail.com</email><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Connie</forename><surname>Marras</surname></persName><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Janis</forename><surname>Miyasaki</surname></persName><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Elena</forename><surname>Moro</surname></persName><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Melissa J</forename><surname>Armstrong</surname></persName><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Antonio P</forename><surname>Strafella</surname></persName><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Binit B</forename><surname>Shah</surname></persName><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Susan</forename><surname>Fox</surname></persName><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">L K</forename><surname>Prashanth</surname></persName><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Nicolas</forename><surname>Phielipp</surname></persName><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Anthony E</forename><surname>Lang</surname></persName><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2013-02"></date><biblScope unit="volume">84</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="130">130</biblScope></imprint></monogr><idno type="istex">1383EF35546E812F3C1739C01522FC673BDAF44B</idno><idno type="DOI">10.1136/jnnp-2012-302684</idno><idno type="href">jnnp-84-130.pdf</idno><idno type="ArticleID">jnnp-2012-302684</idno><idno type="PMID">22933817</idno><idno type="Related-article-Href">10.1136/jnnp-2012-303570</idno><idno type="related-article-ID">RA1</idno><idno type="local">jnnp;84/2/130</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2012-08-29</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background Recently, symptoms similar to addictive drug withdrawal have been reported in a structured longitudinal study of patients with idiopathic Parkinson's Disease (PD) withdrawing from dopamine agonists (DA): the dopamine agonist withdrawal syndrome (DAWS). Objectives The objective of this study was to establish the frequency, predictors, and outcomes of DAWS in a movement disorders clinic. Methods We conducted a retrospective chart review of a sample of patients with a clinical diagnosis of PD treated with DA in whom withdrawal or attempted withdrawal of DA was carried out because of adverse effects, or for any other reason. Out of 487 PD patient charts reviewed, 84 were withdrawn from the agonists and were evaluable. Results Thirteen patients (15.5%) met criteria for DAWS (DAWS+) and 71 did not (DAWS−). DAWS developed upon withdrawal from pergolide, pramipexole and ropinirole, and did not respond to levodopa. DAWS outcomes included recovery in less than 6 months in 61%, in more than a year in 23%, and an inability to discontinue DA in 15% of patients. Development of impulse control disorders was the reason for DA withdrawal in all DAWS+, but only in 41% of DAWS− patients (p<0.0001). DAWS+ and DAWS− patients did not differ in other variables. Conclusion DAWS is a disabling complication of DA use. Critical features of the syndrome are the strong link with impulse control disorders, possibly the independence of DA dosage and type, and the resistance to treatment, including levodopa. Further studies are required to characterise those at risk as well as to define an effective treatment.</p></abstract><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>JNNP Patients' choice</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Behavioural manifestations in Parkinson's disease</term></item><item><term>dopamine agonists</term></item><item><term>impulse control disorders</term></item><item><term>Parkinson's disease treatment</term></item><item><term>withdrawal syndrome</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2012-08-29">Created</change><change when="2013-02">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/1383EF35546E812F3C1739C01522FC673BDAF44B/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-id journal-id-type="publisher-id">jnnp</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><abbrev-journal-title>J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">jnnp-2012-302684</article-id><article-id pub-id-type="doi">10.1136/jnnp-2012-302684</article-id><article-id pub-id-type="other">jnnp;84/2/130</article-id><article-id pub-id-type="other">jnnp;jnnp-2012-302684</article-id><article-id pub-id-type="pmid">22933817</article-id><article-id pub-id-type="other">130</article-id><article-id pub-id-type="other">jnnp-2012-302684</article-id><article-categories><subj-group subj-group-type="heading"><subject>Movement disorders</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>JNNP Patients' choice</subject></subj-group><series-title>Research paper</series-title></article-categories><title-group><article-title>Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Pondal</surname><given-names>Margarita</given-names></name></contrib><contrib contrib-type="author"><name><surname>Marras</surname><given-names>Connie</given-names></name></contrib><contrib contrib-type="author"><name><surname>Miyasaki</surname><given-names>Janis</given-names></name></contrib><contrib contrib-type="author"><name><surname>Moro</surname><given-names>Elena</given-names></name></contrib><contrib contrib-type="author"><name><surname>Armstrong</surname><given-names>Melissa J</given-names></name></contrib><contrib contrib-type="author"><name><surname>Strafella</surname><given-names>Antonio P</given-names></name></contrib><contrib contrib-type="author"><name><surname>Shah</surname><given-names>Binit B</given-names></name></contrib><contrib contrib-type="author"><name><surname>Fox</surname><given-names>Susan</given-names></name></contrib><contrib contrib-type="author"><name><surname>Prashanth</surname><given-names>L K</given-names></name></contrib><contrib contrib-type="author"><name><surname>Phielipp</surname><given-names>Nicolas</given-names></name></contrib><contrib contrib-type="author"><name><surname>Lang</surname><given-names>Anthony E</given-names></name></contrib></contrib-group><aff>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</aff><author-notes><corresp><label>Correspondence to</label> Dr Margarita Pondal, Movement Disorders Centre, Toronto Western Hospital, University of Toronto, and the Edmond J. Safra Program in Parkinson's Disease, McLaughlin Pavilion, 7th Floor, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada; <email>mpondals@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>2</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>29</day><month>8</month><year>2012</year></pub-date><volume>84</volume><volume-id pub-id-type="other">84</volume-id><volume-id pub-id-type="other">84</volume-id><issue>2</issue><issue-id pub-id-type="other">jnnp;84/2</issue-id><issue-id pub-id-type="other">2</issue-id><issue-id pub-id-type="other">84/2</issue-id><fpage>130</fpage><history><date date-type="received"><day>15</day><month>3</month><year>2012</year></date><date date-type="rev-recd"><day>12</day><month>7</month><year>2012</year></date><date date-type="accepted"><day>1</day><month>8</month><year>2012</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2013</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-84-130.pdf"></self-uri><related-article id="RA1" related-article-type="companion" ext-link-type="doi" xlink:href="10.1136/jnnp-2012-303570"></related-article><abstract><sec><title>Background</title><p>Recently, symptoms similar to addictive drug withdrawal have been reported in a structured longitudinal study of patients with idiopathic Parkinson's Disease (PD) withdrawing from dopamine agonists (DA): the dopamine agonist withdrawal syndrome (DAWS).</p></sec><sec><title>Objectives</title><p>The objective of this study was to establish the frequency, predictors, and outcomes of DAWS in a movement disorders clinic.</p></sec><sec><title>Methods</title><p>We conducted a retrospective chart review of a sample of patients with a clinical diagnosis of PD treated with DA in whom withdrawal or attempted withdrawal of DA was carried out because of adverse effects, or for any other reason. Out of 487 PD patient charts reviewed, 84 were withdrawn from the agonists and were evaluable.</p></sec><sec><title>Results</title><p>Thirteen patients (15.5%) met criteria for DAWS (DAWS+) and 71 did not (DAWS−). DAWS developed upon withdrawal from pergolide, pramipexole and ropinirole, and did not respond to levodopa. DAWS outcomes included recovery in less than 6 months in 61%, in more than a year in 23%, and an inability to discontinue DA in 15% of patients. Development of impulse control disorders was the reason for DA withdrawal in all DAWS+, but only in 41% of DAWS− patients (p<0.0001). DAWS+ and DAWS− patients did not differ in other variables.</p></sec><sec><title>Conclusion</title><p>DAWS is a disabling complication of DA use. Critical features of the syndrome are the strong link with impulse control disorders, possibly the independence of DA dosage and type, and the resistance to treatment, including levodopa. Further studies are required to characterise those at risk as well as to define an effective treatment.</p></sec></abstract><kwd-group><kwd>Behavioural manifestations in Parkinson's disease</kwd><kwd>dopamine agonists</kwd><kwd>impulse control disorders</kwd><kwd>Parkinson's disease treatment</kwd><kwd>withdrawal syndrome</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><partName>Research paper</partName><title>Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><partName>Research paper</partName><title>Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Margarita</namePart><namePart type="family">Pondal</namePart><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>E-mail: mpondals@gmail.com</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Connie</namePart><namePart type="family">Marras</namePart><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Janis</namePart><namePart type="family">Miyasaki</namePart><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Elena</namePart><namePart type="family">Moro</namePart><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Melissa J</namePart><namePart type="family">Armstrong</namePart><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Antonio P</namePart><namePart type="family">Strafella</namePart><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Binit B</namePart><namePart type="family">Shah</namePart><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Susan</namePart><namePart type="family">Fox</namePart><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">L K</namePart><namePart type="family">Prashanth</namePart><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Nicolas</namePart><namePart type="family">Phielipp</namePart><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anthony E</namePart><namePart type="family">Lang</namePart><affiliation>The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><subject><genre>hwp-journal-coll</genre><topic>JNNP Patients' choice</topic></subject><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2013-02</dateIssued><dateCreated encoding="w3cdtf">2012-08-29</dateCreated><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Background Recently, symptoms similar to addictive drug withdrawal have been reported in a structured longitudinal study of patients with idiopathic Parkinson's Disease (PD) withdrawing from dopamine agonists (DA): the dopamine agonist withdrawal syndrome (DAWS). Objectives The objective of this study was to establish the frequency, predictors, and outcomes of DAWS in a movement disorders clinic. Methods We conducted a retrospective chart review of a sample of patients with a clinical diagnosis of PD treated with DA in whom withdrawal or attempted withdrawal of DA was carried out because of adverse effects, or for any other reason. Out of 487 PD patient charts reviewed, 84 were withdrawn from the agonists and were evaluable. Results Thirteen patients (15.5%) met criteria for DAWS (DAWS+) and 71 did not (DAWS−). DAWS developed upon withdrawal from pergolide, pramipexole and ropinirole, and did not respond to levodopa. DAWS outcomes included recovery in less than 6 months in 61%, in more than a year in 23%, and an inability to discontinue DA in 15% of patients. Development of impulse control disorders was the reason for DA withdrawal in all DAWS+, but only in 41% of DAWS− patients (p<0.0001). DAWS+ and DAWS− patients did not differ in other variables. Conclusion DAWS is a disabling complication of DA use. Critical features of the syndrome are the strong link with impulse control disorders, possibly the independence of DA dosage and type, and the resistance to treatment, including levodopa. Further studies are required to characterise those at risk as well as to define an effective treatment.</abstract><subject><genre>Keywords</genre><topic>Behavioural manifestations in Parkinson's disease</topic><topic>dopamine agonists</topic><topic>impulse control disorders</topic><topic>Parkinson's disease treatment</topic><topic>withdrawal syndrome</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID">jnnp</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2013</date><detail type="volume"><caption>vol.</caption><number>84</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>130</start></extent></part></relatedItem><relatedItem type="reviewOf"><genre>companion</genre><identifier type="related-articleID">RA1</identifier><identifier type="doi">10.1136/jnnp-2012-303570</identifier></relatedItem><identifier type="istex">1383EF35546E812F3C1739C01522FC673BDAF44B</identifier><identifier type="DOI">10.1136/jnnp-2012-302684</identifier><identifier type="href">jnnp-84-130.pdf</identifier><identifier type="ArticleID">jnnp-2012-302684</identifier><identifier type="PMID">22933817</identifier><identifier type="Related-article-Href">10.1136/jnnp-2012-303570</identifier><identifier type="related-article-ID">RA1</identifier><identifier type="local">jnnp;84/2/130</identifier><accessCondition type="use and reproduction" contentType="copyright">Published by the BMJ Publishing Group Limited. 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