Treatment of impulse control disorders in Parkinson’s disease: Practical considerations and future directions

Abstract

Impulse control disorders (ICDs) including compulsive gambling, buying, sexual behaviors, and eating occur relatively frequently in Parkinson disease (PD) with at least one ICD identified in 14% of PD patients in a large, multicenter, observational study. ICDs behaviors range widely in severity but can lead to catastrophic consequences, including financial ruin, divorce, loss of employment, and increased health risks. The main risk factor for ICDs in PD is the use of Dopamine agonists (DAs) and discontinuation of the offending agent is considered first line treatment. However, many patients do not tolerate this intervention as consequence of increased motor and psychiatric disability or appearance of DA withdrawal syndrome. In this article, we review current management strategies and emerging new interventions for treatment of ICDs in PD. Pharmacological treatment should be individualized based on patient's unique neuropsychiatric profile, social support, medical comorbidities, tolerability and motor symptoms.

The neurobiology of impulse control disorders in Parkinson’s disease: from neurotransmitters to neural networks

“…Dopaminergic approaches to treat ICD often fail because adjusting the dopaminergic medication dosage can prompt withdrawal symptoms or exacerbate motor and psychiatric symptoms (Ramirez-Zamora et al 2016). New treatments for ICD by modulating the serotonergic and noradrenergic, or possibly the opioid system, may circumvent this.…”

Impulse control and related disorders in Parkinson’s disease

“…Patients and their relatives should be informed about the possibility of ICDs when levodopa or DAs are prescribed 46 . Clinicians should proactively investigate symptoms of impulsivity at each medical visit.…”

No genetic association between attention-deficit/hyperactivity disorder (ADHD) and Parkinson’s disease in nine ADHD candidate SNPs

“…Cognitive and executive dysfunction is prevalent in both disorders (Craig et al 2016; Goldman et al 2015). Impulse control disorders including compulsive gambling, shopping, sexual behaviors and eating occur relatively frequently in PD (Ramirez-Zamora et al 2016) and are often observed as an adverse reaction to PD treatment with dopaminergic drugs and deep brain stimulation of the subthalamic nucleus (for review, see Volkmann et al 2010). Dopamine (DA) has long been known to be a crucial modulator of striatal processing of cortical and thalamic signals, mediated through glutamatergic synapses on the principal striatal neurons (medium spiny).…”