Treatment of impulse control disorders in Parkinson’s disease: Practical considerations and future directions

ABSTRACT

Impulse control disorders (ICDs) including compulsive gambling, buying, sexual behaviors, and eating occur relatively frequently in Parkinson disease (PD) with at least one ICD identified in 14% of PD patients in a large, multicenter, observational study. ICDs behaviors range widely in severity but can lead to catastrophic consequences, including financial ruin, divorce, loss of employment, and increased health risks. The main risk factor for ICDs in PD is the use of Dopamine agonists (DAs) and discontinuation of the offending agent is considered first line treatment. However, many patients do not tolerate this intervention as consequence of increased motor and psychiatric disability or appearance of DA withdrawal syndrome. In this article, we review current management strategies and emerging new interventions for treatment of ICDs in PD. Pharmacological treatment should be individualized based on patient’s unique neuropsychiatric profile, social support, medical comorbidities, tolerability and motor symptoms.

KEYWORDS:

• Impulse control disorders
• Parkinson’s disease
• Pathological gambling
• Compulsive eating and shopping
• Punding
• Hypersexuality
• STN DBS
• Dopamine Dysregulation Syndrome

Financial and competing interests disclosure

The authors were supported by The Phyllis E. Dake Endowed Chair in Movement Disorders (A Ramirez-Zamora). A Ramirez-Zamora received research grant support: Boston Scientific and Medtronic, and personal compensation (speaker bureau): Teva Neurosciences. L Gee received scholarship support through the ‘Gary and Janis Grover Research Scholar award’. J Boyd received research grant support: AbbVie, Auspex, Biotie, NIH, MJ Fox Foundation, Cure Huntington Disease Initiative Frederick C. Binter Center for Parkinson’s Disease and Movement Disorders, and personal compensation (advisory board, consultancy, honoraria): AbbVie, Auspex, Lundbeck. J Biller is the Editor of Stroke and cerebrovascular diseases, Chief field Editor Frontiers in Neurology. Royalties, Stroke Editorial board member and up-to-date. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.