Long-term follow-up of impulse control disorders in Parkinson's disease

Authors

  • Eugenia Mamikonyan MS,

    1. Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
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    • Dr. Potenza has been a consultant to Boehringer Ingelheim, received research support from Mohegan Sun, has been a consultant to and has financial interests in Somaxon, and has consulted for law offices and the federal defender's office as an expert in pathological gambling and impulse control disorders. Dr. Siderowf has been a consultant to Boehringer Ingelheim, Teva Pharmaceuticals, and UCP Inc. Dr. Stern has received grant support from and been a consultant to Boehringer Ingelheim and Teva Pharmaceuticals. Dr. Weintraub has received research support from and has been a consultant to Boehringer Ingelheim, and has been a consultant to Schwarz Pharma. Dr. Duda, Dr. Horn, and Ms. Mamikonyan have no disclosures.

  • Andrew D. Siderowf MD, MSCE,

    1. Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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    • Dr. Potenza has been a consultant to Boehringer Ingelheim, received research support from Mohegan Sun, has been a consultant to and has financial interests in Somaxon, and has consulted for law offices and the federal defender's office as an expert in pathological gambling and impulse control disorders. Dr. Siderowf has been a consultant to Boehringer Ingelheim, Teva Pharmaceuticals, and UCP Inc. Dr. Stern has received grant support from and been a consultant to Boehringer Ingelheim and Teva Pharmaceuticals. Dr. Weintraub has received research support from and has been a consultant to Boehringer Ingelheim, and has been a consultant to Schwarz Pharma. Dr. Duda, Dr. Horn, and Ms. Mamikonyan have no disclosures.

  • John E. Duda MD,

    1. Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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    • Dr. Potenza has been a consultant to Boehringer Ingelheim, received research support from Mohegan Sun, has been a consultant to and has financial interests in Somaxon, and has consulted for law offices and the federal defender's office as an expert in pathological gambling and impulse control disorders. Dr. Siderowf has been a consultant to Boehringer Ingelheim, Teva Pharmaceuticals, and UCP Inc. Dr. Stern has received grant support from and been a consultant to Boehringer Ingelheim and Teva Pharmaceuticals. Dr. Weintraub has received research support from and has been a consultant to Boehringer Ingelheim, and has been a consultant to Schwarz Pharma. Dr. Duda, Dr. Horn, and Ms. Mamikonyan have no disclosures.

  • Marc N. Potenza MD, PhD,

    1. Department of Psychiatry, Yale University, New Haven, Connecticut
    2. Mental Illness Research, Education and Clinical Center (MIRECC), West Haven Veterans Affairs Medical Center, West Haven, Connecticut
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    • Dr. Potenza has been a consultant to Boehringer Ingelheim, received research support from Mohegan Sun, has been a consultant to and has financial interests in Somaxon, and has consulted for law offices and the federal defender's office as an expert in pathological gambling and impulse control disorders. Dr. Siderowf has been a consultant to Boehringer Ingelheim, Teva Pharmaceuticals, and UCP Inc. Dr. Stern has received grant support from and been a consultant to Boehringer Ingelheim and Teva Pharmaceuticals. Dr. Weintraub has received research support from and has been a consultant to Boehringer Ingelheim, and has been a consultant to Schwarz Pharma. Dr. Duda, Dr. Horn, and Ms. Mamikonyan have no disclosures.

  • Stacy Horn DO,

    1. Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Matthew B. Stern MD,

    1. Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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    • Dr. Potenza has been a consultant to Boehringer Ingelheim, received research support from Mohegan Sun, has been a consultant to and has financial interests in Somaxon, and has consulted for law offices and the federal defender's office as an expert in pathological gambling and impulse control disorders. Dr. Siderowf has been a consultant to Boehringer Ingelheim, Teva Pharmaceuticals, and UCP Inc. Dr. Stern has received grant support from and been a consultant to Boehringer Ingelheim and Teva Pharmaceuticals. Dr. Weintraub has received research support from and has been a consultant to Boehringer Ingelheim, and has been a consultant to Schwarz Pharma. Dr. Duda, Dr. Horn, and Ms. Mamikonyan have no disclosures.

  • Daniel Weintraub MD

    Corresponding author
    1. Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
    3. Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
    4. Mental Illness Research, Education and Clinical Center (MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
    • Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
    Search for more papers by this author
    • Dr. Potenza has been a consultant to Boehringer Ingelheim, received research support from Mohegan Sun, has been a consultant to and has financial interests in Somaxon, and has consulted for law offices and the federal defender's office as an expert in pathological gambling and impulse control disorders. Dr. Siderowf has been a consultant to Boehringer Ingelheim, Teva Pharmaceuticals, and UCP Inc. Dr. Stern has received grant support from and been a consultant to Boehringer Ingelheim and Teva Pharmaceuticals. Dr. Weintraub has received research support from and has been a consultant to Boehringer Ingelheim, and has been a consultant to Schwarz Pharma. Dr. Duda, Dr. Horn, and Ms. Mamikonyan have no disclosures.


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 long-term outcomes of affected patients. To report on the clinical interventions and long-term outcomes of PD patients who developed an ICD after DA initiation. Subjects contacted by telephone for a follow-up 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 self-rated changes in their ICD symptomatology. Baseline and follow-up dopamine replacement therapy use was recorded and verified by chart review. Of 18 subjects, 15 (83.3%) participated in the follow-up interview. At follow-up, patients were receiving a significantly lower DA levodopa equivalent daily dosage (LEDD) (Z = −3.1, P = 0.002) and a higher daily levodopa dosage (Z = −1.9, P = 0.05), but a similar total LEDD dosage (Z = −0.47, P = 0.64) with no changes in Unified Parkinson's Disease Rating Scale motor score (Z = −1.3, 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 self-report, 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. © 2007 Movement Disorder Society

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