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 longโterm outcomes of affected patients. To report on the clinical interventions and longโterm outcomes of PD patients who developed an ICD after DA initiation. Subjects contacted by telephone for a followโup 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 selfโrated changes in their ICD symptomatology. Baseline and followโup dopamine replacement therapy use was recorded and verified by chart review. Of 18 subjects, 15 (83.3%) participated in the followโup interview. At followโup, patients were receiving a significantly lower DA levodopa equivalent daily dosage (LEDD) (Z = โ3.1, P = 0.002) and a higher daily levodopa dosage (Z = โ1.9, P = 0.05), but a similar total LEDD dosage (Z = โ0.47, P = 0.64) with no changes in Unified Parkinson's Disease Rating Scale motor score (Z = โ1.3, 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 selfโreport, 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. ยฉ 2007 Movement Disorder Society