title: Treatment of juvenile Parkinson disease and the recurrent emergence of pathologic gambling.
abstract: OBJECTIVE
  To describe the recurrent emergence of pathologic gambling (PG) during the sequential treatment of a patient with Juvenile Parkinson disease (PD) with different dopamine agonists.
  
  
  METHODS
  Single case report.
  
  
  RESULTS
  A patient with Juvenile PD developed PG soon after beginning treatment with pergolide, a mixed D1/D2 dopamine agonist that is also supposed to exhibit D3 activity. This behavior remitted upon the discontinuation of the drug. A subsequent therapeutic trial with pramipexole, a dopamine agonist with preferential D3 dopamine receptor activity, resulted in the recurrence of PG. Remarkably, previous treatment with levodopa was not associated with this side effect.
  
  
  CONCLUSIONS
  These findings seem to confirm previous suggestions that dopaminergic hyperactivity plays an important role in the pathogenesis of PG. They further indicate that patients with PD may develop PG as a side effect of more than one dopamine agonist. There is still no consensus regarding the best strategy to deal with this potentially disturbing phenomenon.
authors.affiliation: Programa de Ansiedade e Depressão do Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil.
authors.forename: Rafael Ferreira
authors.initials: RF
authors.lastname: Garcia
authors.forename: Lidia
authors.initials: L
authors.lastname: Ordacgi
authors.forename: Mauro V
authors.initials: MV
authors.lastname: Mendlowicz
authors.forename: Gabriel R
authors.initials: GR
authors.lastname: de Freitas
authors.forename: Ana Lucia Z
authors.initials: AL
authors.lastname: Rosso
authors.forename: Bruno P
authors.initials: BP
authors.lastname: Nazar
authors.forename: Leonardo F
authors.initials: LF
authors.lastname: Fontenelle
mesh_terms: D000293:Adolescent; D000328:Adult; D000978:Antiparkinson Agents / Q000009:adverse effects* / Q000627:therapeutic use; D052160:Benzothiazoles / Q000009:adverse effects* / Q000627:therapeutic use; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000139:chemically induced / Q000523:psychology; D018491:Dopamine Agonists / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005715:Gambling / Q000523:psychology*; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D020734:Parkinsonian Disorders / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D010479:Pergolide / Q000009:adverse effects* / Q000627:therapeutic use; D000077487:Pramipexole; D012008:Recurrence
chemical_list: D000978:Antiparkinson Agents; D052160:Benzothiazoles; D018491:Dopamine Agonists; D010479:Pergolide; D007980:Levodopa; D000077487:Pramipexole