Newswise, April 7, 2016 – Drugs commonly prescribed
to treat Parkinson’s disease have been linked to impulse control disorders such
as pathological gambling, compulsive buying, hypersexuality and binge eating in
some patients, according to a review article by neurologists at Loyola Medicine
and Loyola University Chicago Stritch School of Medicine.
These disorders can have disastrous personal,
professional and financial consequences if not recognized or treated, according
to the article in the journal Expert Review of Neurotherapeutics. Authors of
the paper include José Biller, MD, and first author Adolfo Ramirez-Zamora, MD,
who completed a residency in neurology at Loyola.
The paper details the latest findings for treating
impulse control disorders (ICDs) in Parkinson’s disease patients, including
adjusting medications, deep brain stimulation and a counseling technique called
cognitive behavioral therapy.
One large, previous national study found that
approximately 14 percent of Parkinson’s disease patients experience at least
one ICD. The disorders are more common in men.
Men are more likely to display hypersexuality and
pathological gambling, while women are more likely to exhibit compulsive eating
and buying. Potentially catastrophic consequences include financial ruin,
divorce and loss of employment.
Patients often lack insight and underestimate the
presence and severity of ICDs and related conditions, the authors write. ICDs
are probably more prevalent in Parkinson’s disease patients than previously
reported.
The primary risk factor for ICDs is the use of a
class of Parkinson’s disease medications called dopamine agonists, which help
control tremors and other Parkinson’s symptoms.
These drugs include pramipexole (Mirapex®) and
ropinirole (Requip®). Other risk factors include younger age, smoking, alcohol
abuse and personality traits such as impulsivity, obsessive-compulsive
disorder, depression and anxiety.
Management of ICDs is particularly difficult and no
treatment guidelines for ICDs in Parkinson’s patients are available. Treatment
should be individualized, and careful selection of specific interventions is
critical. Treatments that have been considered include switching, reducing or
discontinuing Parkinson’s medications.
But this can be challenging. Patients often are
reluctant to change medications because they do not want their tremors to get
worse. Patients also can experience withdrawal symptoms when taken off dopamine
agonists, including anxiety, panic attacks, depression, irritability and
fatigue.
The authors discuss alternative treatment strategies
for Parkinson’s disease and medications that may help control ICDs, such as
antidepressants, atypical antipsychotics and antiepileptic drugs.
Other potential nondrug treatments include cognitive
behavioral therapy and a “brain pacemaker” called deep brain stimulation. The
authors provide a much-needed, practical and detailed review of the factors
important making management decisions
Families also play a critical role. Spouses and
other family members should be warned that Parkinson’s medications can cause
ICDs. Families should report to the patient’s physician any “unexplained
absences, changes in routine behaviors, irritability, hiding evidence of the
impulse control disorders and monetary consequences,” the authors write.
Helpful non-pharmacological approaches include limiting access to bank
accounts, credit cards and the internet.
Dr. Biller is chair of the department of neurology of Loyola University Chicago Stritch School of Medicine. Dr Ramirez-Zamora, a former resident in Loyola’s department of neurology, is now at Albany Medical College and serves as the Phyllis E. Duke Endowed Chair in Movement Disorders. Other co-authors are Lucy Gee of Albany Medical College and James Boyd, MD, of the University of Vermont College of Medicine.
Their article is titled, “Treatment of impulse
control disorders in Parkinson’s disease: Practical considerations and future
directions.”
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