The unintentional development of a compulsive gambling disorder after a medical treatment is discussed in a new case report from the Mayo Clinic. Although the extent of the problem is unknown, treatment of a particular neurological syndrome with medications that stimulate dopamine receptors in the brain appear to trigger the disorder.
The Mayo Clinic study is the first to describe the iatrogenic disorder among patients with restless legs syndrome (RLS). RLS is neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move them for relief of unknown cause. RLS is generally a life-long condition for which there is no cure.
The development of pathological gambling has been documented among patients with Parkinson disease who require high doses of medications called dopamine agonists However, the new finding shows that gambling is not restricted to patients with Parkinson disease — and also can occur after the administration of low dosages of medication.
The report appeared in the Jan. 23 issue of Neurology.
According to the study, the disorder occurs only in a small number of RLS patients treated with drugs called dopamine agonists. Considering this potential side effect of dopamine agonists, the Mayo Clinic authors suggest that physicians screen all RLS patients for compulsive behaviors while taking a thorough medical history prior to prescribing dopamine agonists.
Patients should be monitored closely for signs of compulsive behaviors once dopamine agonist treatment has begun. The report suggests that the compulsion to gamble worsened with increasing doses of the dopamine agonists.
Pathological gambling is an impulse control disorder. In 2005, Mayo Clinic physicians reported this disorder as a side effect of dopamine agonist therapy in 11 Parkinson disease patients.
“Although pathologic gambling has already been recognized in patients with Parkinson disease who often took high doses of dopamine agonists, the current report suggests that pathological gambling is not restricted to patients with Parkinson disease — and also can occur at low dosages” explains Maja Tippmann-Peikert, M.D., the lead author of the Mayo Clinic report on restless legs syndrome.
“Physicians should not only monitor Parkinson disease patients for this behavior but also screen their RLS patients who may be on much lower doses of dopamine agonists.”
This includes encouraging the patient, family members and friends to report negative behaviors to the patient’s physician.
Fortunately, pathological gambling seems to be reversible when the dose of the dopamine agonist is reduced or the patient is transitioned to an alternative medication. It is crucial that these adjustments are initiated before significant gambling debts develop, and relationships and careers are damaged.
Significance of the Mayo Clinic Report
This preliminary Mayo Clinic report is the first to link pathologic gambling to use of dopamine agonists in a disease other than Parkinson. It is based on the experience of three patients who have RLS. Their gambling problems were discovered during their medical evaluations at the Mayo Clinic Sleep Disorders Center.
Although three patients is a small sample and larger studies are needed to validate these observations, the Mayo Clinic authors believe that the possible link between dopamine agonists and pathologic gambling behavior should be brought to physicians’ attention immediately due to the social and financial consequences resulting from the behavior.
Source: Mayo Clinic