Treatment for Impulse Control Disorders in Parkinson's

Close-Up Of Gambling Chips With Cards On Table
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Have you found that when you take your Parkinson’s disease medications you sometimes feel less inhibited, more energetic and indeed more impulsive? Has your impulsivity ever gotten you into trouble? Has your caregiver ever expressed concern about some of your ‘new’ behaviors-behaviors that emerge after you take your PD medications? Some dopamine medications used to treat Parkinson's disease cause you to develop strange new behaviors including compulsive gambling, spending, eating, hypersexuality, and punding.

The good news is that most forms of impulse control disorder (ICD) can be treated by adjusting medication dosage levels. But sometimes simply adjusting dose levels does not work. What do you do them? Unfortunately, little solid information is out there on treatment strategies for ICDs in PD beyond medication adjustments. Here are some tips concerning treatment of ICDs in PD gleaned from available sources. Always talk with your doctor to decide what treatment is best for you.

Are You At Risk for ICDs?

First, are you in an at-risk category for ICDs? Are you receiving dopamine agonist therapy and/or higher doses of levodopa? Are you male, with a history of depression, a personal or family history of substance dependence, younger age at PD onset, or early emergence of dyskinesia? Discuss these signs with your doctor and see if you can develop a monitoring system with your doctors help so that you can spot any emerging ICD before it can do you and your family much harm.

If you are in an at-risk category or are currently experiencing an ICD, consider some common sense measures to reduce the impact of an ICD such as restricting access to money sources, blocking Internet sites that involve gambling or pornography; shopping only when a relative or friend is present, and participating in 12-step self-help groups (such as Gamblers, Debtors, or Overeaters Anonymous).

Switching Medications May Help

Ask your doctor about switching your medications from one type of agonist to another (such as from pramipexole or pergolide to ropinirole or from pramipexole to pergolide),

If adjusting doses or switching your medications does not work, ask your doctor about trying a ‘neuroleptic’ such as haloperidol or pimozide. These drugs reduce dopamine levels in the brain and may help reduce ICD. The problem is that these drugs and the so-called atypical antipsychotics like olanzapine and risperidone may also worsen PD motor function.

There has been some weak evidence that Quetiapine and clozapine successfully treat pathological gambling and hypersexuality in PD. The problem with these drugs is that they worsen PD motor symptoms and they have other serious side effects. Clozapine carries a small risk of agranulocytosis and can be fatal if not discovered early.

Deep brain stimulation has been suggested as a therapy for ICDs in PD but to date, the evidence is mixed on its effectiveness for ICDs.

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Article Sources

  • Isaias IU, Siri C, Cilia R, De Gaspari D, Pezzoli G, Antonini A. The Relationship Between Impulsivity and Impulse Control Disorders in Parkinson's Disease. Mov Disord. 2008 Feb 15;23(3):411-5.
  • Lim SY, Evans AH, Miyasaki JM. Ann. Impulse Control and Related Disorders in Parkinson's Disease: review. N Y Acad Sci. 2008 Oct;1142:85-107.
  • Weintraub D. Review. Dopamine and Impulse Control Disorders in Parkinson's Disease. Ann Neurol. 2008 Dec;64 Suppl 2:S93-100.