Treatment of impulse control disorders and dopamine agonist withdrawal syndrome in Parkinson’s disease

Abstract

Parkinson’s disease (PD) patients who are treated with a dopamine agonist (DA) frequently develop impulse control disorders (ICDs) such as compulsive eating, shopping/buying, pathological gambling, or hypersexuality. The secondary consequences of ICDs can be severe, and the only known effective treatment is to taper or discontinue DA therapy. Unfortunately, about 20% of patients who attempt to taper a DA develop dopamine agonist withdrawal syndrome (DAWS), with symptoms such as anxiety/panic, dysphoria, apathy, suicidality, orthostatic hypotension, diaphoresis, anorexia, nausea/vomiting, and fatigue. In some cases, DAWS may be so severe and long-lasting that affected patients are unable to taper DA therapy and experience permanent ICDs. Preventative strategies for ICDs and DAWS are therefore critical.