Background: Dopamine Dysregulation Syndrome (DDS)
is an adverse non-motor complication of dopamine replacement therapy in
Parkinson’s Disease. The current literature on DDS is limited, and it
remains underdiagnosed and challenging to manage.
Methods: We performed a retrospective chart
review and classified patients according to risk factors that have been
identified in the literature, UPDRS scores, intervention and outcome.
Univariate analyses were performed to quantify these characteristics.
Results: Prior psychiatric illness was identified
in 70% of patients, impulse control disorder in 89% and substance abuse in
3.7%. Interventions included reduction of dopamine therapy (88.9%), deep
brain stimulation (DBS) of the subthalamic nucleus (STN, 48.1%) or globus
pallidus interna (GPi, 7.4%), and levodopa-carbidopa intestinal gel (LCIG)
infusion (11.1%). Baseline UPDRS IV before treatment and MDS III after
treatment were not significant between intervention groups (p=0.09 and
p=0.13 respectively). Overall 88.9% patients improved at follow up, with
medication only (75%), STN DBS (100%), GPi DBS (100%) and LCIG (33%).
Relapse rate was 18.2%, in the STN group only.
Conclusions: Our results suggest that GPi DBS, in
concurrence with dopaminergic medication reduction, is the most effective
intervention. STN DBS might be also beneficial although the associated
medications reduction causes DDS relapse in a subgroup of patients.