Management of impulse control disorders in Parkinson's disease

Impulse control disorders (ICDs) are a set of behaviors, including pathologic gambling, hypersexuality, compulsive shopping, compulsive eating, and punding, which are now recognized to occur in a subset of patients with Parkinson's disease (PD). Although the underlying pathophysiology of these behaviors is poorly understood, they appear to be associated with the use, and sometimes overuse, of dopaminergic agents prescribed for the treatment of the motor symptoms of PD. At present, there are limited data to support any particular therapeutic strategy. Approaches worth considering in the management of the PD patient with an ICD include reduction or discontinuation of dopamine agonist therapy, trials of various pharmacologic agents, psychosocial interventions, and deep brain stimulation of the subthalamic nucleus. However, the management of each patient must be tailored for the particular clinical setting, and the development of evidence-based treatment strategies awaits future prospective studies and randomized controlled trials.