Dopamine-agonists — medications that are commonly prescribed to treat the symptoms of Parkinson’s disease — have been linked to impulse control disorders (ICDs) such as pathological gambling, compulsive buying, hypersexuality and binge eating in some patients, according to a new report by neurologists at Loyola Medicine and Loyola University Chicago Stritch School of Medicine.
Parkinson’s patients take dopamine agonists, such as pramipexole (Mirapex) and ropinirole (Requip), to help control tremors, stiffness and muscle spasms.
Men are at greater risk for ICDs and are more likely to experience hypersexuality and pathological gambling. Women, however, are more likely to take part in compulsive eating and buying. Patients often lack insight and underestimate the presence and severity of ICDs and related conditions, report the researchers.
In a large, previous national study, researchers found that about 14 percent of Parkinson’s disease patients experience at least one ICD. According to the new findings, however, ICDs are probably more prevalent in Parkinson’s disease patients than previously reported.
“ICDs can have disastrous personal, professional and financial consequences if not recognized or treated, and may lead to divorce, unemployment and financial ruin,” says authors José Biller, M.D. and Adolfo Ramirez-Zamora, M.D.
Their new report details the latest findings for treating impulse control disorders in Parkinson’s disease patients, including adjusting medications, deep brain stimulation, and cognitive behavioral therapy.
Management of ICDs is extremely difficult and no treatment guidelines are currently available for Parkinson’s patients with this condition. Treatments that have been considered include switching, reducing or discontinuing Parkinson’s medications, but this can be very challenging.
Patients often are reluctant to change medications because they do not want their tremors to get worse. Patients also can experience withdrawal symptoms when taken off dopamine agonists, resulting in anxiety, panic attacks, depression, irritability, and fatigue. It is critical that treatment be individualized and that specific interventions are carefully selected.
In the report, the authors discuss alternative treatment strategies for Parkinson’s disease and medications that may help control ICDs, such as antidepressants, atypical antipsychotics and antiepileptic drugs. Other potential nondrug treatments include cognitive behavioral therapy and deep brain stimulation.
Family members and relatives can play a critical role as well. Spouses and other family members should be warned that Parkinson’s medications can lead to ICDs. Families should report to the patient’s physician any “unexplained absences, changes in routine behaviors, irritability, hiding evidence of the impulse control disorders and monetary consequences,” the authors write. Family members may also want to monitor the patient’s access to bank accounts, credit cards and the internet.
Other risk factors for developing ICDs while on dopamine-agonists include being a younger age, smoking, alcohol abuse and personality traits such as impulsivity, obsessive-compulsive disorder, depression, and anxiety.
The authors report their findings in the journal Expert Review of Neurotherapeutics.
Source: Loyola University Health System