Parkinson's disease management and impulse control disorders: current state and future perspectives

Area of Science:

• Neurology
• Movement Disorders
• Pharmacology

Background:

• Impulse control disorders (ICDs) are common in Parkinson's disease (PD), often associated with dopamine replacement therapy (DRT), particularly dopamine agonists (DA).
• ICDs significantly impair daily living and reduce the quality of life for patients with PD and their families.
• Dopamine agonist withdrawal (DAWS) syndrome is a critical consideration in managing ICDs.

Purpose of the Study:

• To review common ICDs in PD within the context of current management strategies.
• To highlight controversial areas requiring further research.
• To discuss the implications of DAWS and novel therapeutic approaches for ICDs in PD.

Main Methods:

• Literature review focusing on impulse control disorders in Parkinson's disease.
• Analysis of current management strategies, including pharmacological and non-pharmacological treatments.
• Discussion of dopamine agonist withdrawal syndrome and its impact on treatment.

Main Results:

• Management of ICDs in PD primarily involves dose reduction, discontinuation, or switching of dopaminergic agents, especially DA.
• Close patient monitoring is essential during treatment adjustments due to potential motor deterioration and DAWS.
• Assessment of ICDs should be continuous throughout the disease course, not solely tied to DRT initiation or dosage changes.

Conclusions:

• Reducing or altering dopaminergic therapy is the cornerstone of managing ICDs in PD.
• Careful monitoring for motor symptoms and DAWS is crucial when adjusting DRT.
• Continuous assessment of ICDs is necessary, as their development is not strictly dose-dependent on DRT.