Piribedil and Pathological Gambling in six Parkinsonian patients

Impulse control disorders (ICD) in Parkinson's disease (PD) have attracted increasing interest. They are characterized by the inability to control the impulse to perform an act that can be detrimental to them or to others. Although dopamine agonists (DA), as a group, have been associated with impulse control disorders (ICD), piribedil has rarely been reported to cause them. Method Case reports of six parkinsonian patients on piribedil presenting pathological gambling (PG). Results All of the patients presented ICD associated with piribedil use. Two of them received this medication as first treatment and four of them who had developed ICDs secondary to other DA that reappeared with piribedil. Conclusion Despite piribedil is commercially available in only a few countries, it should be considered in the differential diagnosis of PG in patients with PD.

Download Full-text

Dopamine and reward hypersensitivity in Parkinson’s disease with impulse control disorder

Brain ◽

10.1093/brain/awaa198 ◽

2020 ◽

Vol 143 (8) ◽

pp. 2502-2518

Author(s):

Daniel S Drew ◽

Kinan Muhammed ◽

Fahd Baig ◽

Mark Kelly ◽

Youssuf Saleh ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Impulse Control ◽

Dopamine Agonists ◽

Impulse Control Disorders ◽

Reward Sensitivity ◽

Impulse Control Disorder ◽

Dopaminergic Medication ◽

Neuropsychiatric Complications ◽

Pupillary Responses

Abstract Impulse control disorders in Parkinson’s disease are common neuropsychiatric complications associated with dopamine replacement therapy. Some patients treated with dopamine agonists develop pathological behaviours, such as gambling, compulsive eating, shopping, or disinhibited sexual behaviours, which can have a severe impact on their lives and that of their families. In this study we investigated whether hypersensitivity to reward might contribute to these pathological behaviours and how this is influenced by dopaminergic medication. We asked participants to shift their gaze to a visual target as quickly as possible, in order to obtain reward. Critically, the reward incentive on offer varied over trials. Motivational effects were indexed by pupillometry and saccadic velocity, and patients were tested ON and OFF dopaminergic medication, allowing us to measure the effect of dopaminergic medication changes on reward sensitivity. Twenty-three Parkinson’s disease patients with a history of impulse control disorders were compared to 26 patients without such behaviours, and 31 elderly healthy controls. Intriguingly, behavioural apathy was reported alongside impulsivity in the majority of patients with impulse control disorders. Individuals with impulse control disorders also exhibited heightened sensitivity to exogenous monetary rewards cues both ON and OFF (overnight withdrawal) dopamine medication, as indexed by pupillary dilation in anticipation of reward. Being OFF dopaminergic medication overnight did not modulate pupillary reward sensitivity in impulse control disorder patients, whereas in control patients reward sensitivity was significantly reduced when OFF dopamine. These effects were independent of cognitive impairment or total levodopa equivalent dose. Although dopamine agonist dose did modulate pupillary responses to reward, the pattern of results was replicated even when patients with impulse control disorders on dopamine agonists were excluded from the analysis. The findings suggest that hypersensitivity to rewards might be a contributing factor to the development of impulse control disorders in Parkinson’s disease. However, there was no difference in reward sensitivity between patient groups when ON dopamine medication, suggesting that impulse control disorders may not emerge simply because of a direct effect of dopaminergic drug level on reward sensitivity. The pupillary reward sensitivity measure described here provides a means to differentiate, using a physiological measure, Parkinson’s disease patients with impulse control disorder from those who do not experience such symptoms. Moreover, follow-up of control patients indicated that increased pupillary modulation by reward can be predictive of the risk of future emergence of impulse control disorders and may thereby provide the potential for early identification of patients who are more likely to develop these symptoms.

Download Full-text

Impulse Control Disorders Following Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease: Clinical Aspects

Parkinson s Disease ◽

10.4061/2011/658415 ◽

2011 ◽

Vol 2011 ◽

pp. 1-9 ◽

Cited By ~ 14

Author(s):

Polyvios Demetriades ◽

Hugh Rickards ◽

Andrea Eugenio Cavanna

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Impulse Control ◽

Case Reports ◽

Impulse Control Disorders ◽

Clinical Aspects ◽

Dopaminergic Medication ◽

Deep Brain

Parkinson's disease (PD) has been associated with the development of impulse control disorders (ICDs), possibly due to overstimulation of the mesolimbic system by dopaminergic medication. Preliminary reports have suggested that deep brain stimulation (DBS), a neurosurgical procedure offered to patients with treatment-resistant PD, affects ICD in a twofold way. Firstly, DBS allows a decrease in dopaminergic medication and hence causes an improvement in ICDs. Secondly, some studies have proposed that specific ICDs may develop after DBS. This paper addresses the effects of DBS on ICDs in patients with PD. A literature search identified four original studies examining a total of 182 patients for ICDs and nine case reports of 39 patients that underwent DBS and developed ICDs at some point. Data analysis from the original studies did not identify a significant difference in ICDs between patients receiving dopaminergic medication and patients on DBS, whilst the case reports showed that 56% of patients undergoing DBS had poor outcome with regards to ICDs. We discuss these ambivalent findings in the light of proposed pathogenetic mechanisms. Longitudinal, prospective studies with larger number of patients are required in order to fully understand the role of DBS on ICDs in patients with PD.

Download Full-text

1.113 PATHOLOGICAL GAMBLING AND RISK FOR IMPULSE CONTROL DISORDERS IN PARKINSON'S DISEASE: A COMMUNITY BASED STUDY

Parkinsonism & Related Disorders ◽

10.1016/s1353-8020(11)70227-9 ◽

2012 ◽

Vol 18 ◽

pp. S38

Author(s):

J. Joutsa ◽

K. Martikainen ◽

T. Vahlberg ◽

V. Voon ◽

V. Kaasinen

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Pathological Gambling ◽

Impulse Control ◽

Impulse Control Disorders ◽

Community Based

Download Full-text

Non-motor symptom burden in patients with Parkinson’s disease with impulse control disorders and compulsive behaviours: results from the COPPADIS cohort

Scientific Reports ◽

10.1038/s41598-020-73756-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

S. Jesús ◽

◽

M. A. Labrador-Espinosa ◽

A. D. Adarmes ◽

C. Méndel-Del Barrio ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Impulse Control ◽

Dopamine Agonists ◽

Rating Scale ◽

Disease Onset ◽

Impulse Control Disorders ◽

Nonmotor Symptoms ◽

Premorbid Personality ◽

Validated Questionnaire

Abstract The study was aimed at analysing the frequency of impulse control disorders (ICDs) and compulsive behaviours (CBs) in patients with Parkinson’s disease (PD) and in control subjects (CS) as well as the relationship between ICDs/CBs and motor, nonmotor features and dopaminergic treatment in PD patients. Data came from COPPADIS-2015, an observational, descriptive, nationwide (Spain) study. We used the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) for ICD/CB screening. The association between demographic data and ICDs/CBs was analyzed in both groups. In PD, this relationship was evaluated using clinical features and treatment-related data. As result, 613 PD patients (mean age 62.47 ± 9.09 years, 59.87% men) and 179 CS (mean age 60.84 ± 8.33 years, 47.48% men) were included. ICDs and CBs were more frequent in PD (ICDs 12.7% vs. 1.6%, p < 0.001; CBs 7.18% vs. 1.67%, p = 0.01). PD patients had more frequent previous ICDs history, premorbid impulsive personality and antidepressant treatment (p < 0.05) compared with CS. In PD, patients with ICDs/CBs presented younger age at disease onset, more frequent history of previous ICDs and premorbid personality (p < 0.05), as well as higher comorbidity with nonmotor symptoms, including depression and poor quality of life. Treatment with dopamine agonists increased the risk of ICDs/CBs, being dose dependent (p < 0.05). As conclusions, ICDs and CBs were more frequent in patients with PD than in CS. More nonmotor symptoms were present in patients with PD who had ICDs/CBs compared with those without. Dopamine agonists have a prominent effect on ICDs/CBs, which could be influenced by dose.

Download Full-text

Analysis of Impulse Control Disorders (ICDs) and Factors Associated with Their Development in a Parkinson’s Disease Population

Healthcare ◽

10.3390/healthcare9101263 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1263

Author(s):

Mauricio Iván García-Rubio ◽

María Elisa Otero-Cerdeira ◽

Christian Gabriel Toledo-Lozano ◽

Sofía Lizeth Alcaraz-Estrada ◽

Juan Antonio Suárez-Cuenca ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Binge Eating ◽

Impulse Control ◽

Dopamine Agonists ◽

Protective Factor ◽

Impulse Control Disorders ◽

Compulsive Shopping ◽

Factors Associated ◽

Clinical Records

Parkinson’s disease (PD) is a neurodegenerative disease in which non-motor symptoms may appear before motor phenomena, which include Impulse Control Disorders (ICDs). The objective of this study is to identify factors associated with the development of ICDs in PD. An analytical, cross-sectional study was conducted using clinical records from patients diagnosed with PD, both genders, from 40 to 80 years old. Clinical and demographic data were collected: 181 patients were recruited; 80 of them showed PD and ICDs, and they constituted the study group, whereas 101 patients with PD without ICDs constituted the control reference group. The duration of PD was longer in the group with ICDs (p < 0.008), and all patients showed at least one ICD: binge eating (61.29%), compulsive shopping (48.75%), hypersexuality (23.75%), gambling behavior (8.75%), and punding (3.75%). After logistic regression analysis, only the use of dopamine agonists remained associated with ICDs (p < 0.001), and the tremorgenic form was suggested to be a protective factor (p < 0.001). Positive associations were observed between the rigid-akinetic form and compulsive shopping (p < 0.007), between male and hypersexuality (p < 0.018), and between dopamine agonists and compulsive shopping (p < 0.004), and negative associations were observed between motor fluctuations and compulsive shopping (p < 0.031), between Deep Brain Stimulation and binge eating (p < 0.046), and between levodopa consumption and binge eating (p < 0.045). Binge eating, compulsive shopping, and hypersexuality were the most frequent ICDs. Complex forms and motor complications of PD were associated with the development of ICDs.

Download Full-text