title: Impulse control disorders arising in 3 patients treated with rotigotine.
abstract: OBJECTIVE
  We report 3 cases of impulse control disorders (ICDs) that developed in patients with Parkinson disease treated with the novel dopamine agonist, rotigotine.
  
  
  METHODS
  Three patients were identified retrospectively who developed symptoms of an ICD while taking rotigotine. The ICD symptoms developed at 4, 5, and 8 years after diagnosis of Parkinson disease in these patients and while they were taking rotigotine and levodopa. Other drugs included entacapone, amantadine, and selegiline. The first patient developed symptoms of hypersexuality while taking rotigotine 18 mg (40-cm2 patch) daily and levodopa 300 mg/d. The second patient developed pathological gambling while taking rotigotine 22.5 mg (50-cm2 patch) daily and levodopa 300 mg/d. The third patient developed symptoms of hypersexuality, punding, and pathological gambling, losing more than $100,000 while taking rotigotine 18 mg (40-cm2 patch) and levodopa 400 mg/d. In the first 2 patients, the development of the ICD was temporally associated with an increase in rotigotine dosage, whereas the third patient experienced a dramatic increase in his gambling with the addition of rotigotine. Both subjects who developed pathological gambling had a history of recreational gambling for many years, and 1 of the 2 subjects who developed hypersexuality had a history of cross-dressing since childhood.
  
  
  RESULTS
  The ICDs in these patients were effectively treated with rotigotine reduction or discontinuation.
  
  
  CONCLUSIONS
  Rotigotine has the potential for causing ICD, similar to other dopamine agonists.
authors.affiliation: Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Wingo
authors.forename: Marian
authors.initials: M
authors.lastname: Evatt
authors.forename: Burton
authors.initials: B
authors.lastname: Scott
authors.forename: Alan
authors.initials: A
authors.lastname: Freeman
authors.forename: Mark
authors.initials: M
authors.lastname: Stacy
mesh_terms: D000328:Adult; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000188:drug therapy*; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013764:Tetrahydronaphthalenes / Q000627:therapeutic use*; D013876:Thiophenes / Q000627:therapeutic use*
chemical_list: D018491:Dopamine Agonists; D013764:Tetrahydronaphthalenes; D013876:Thiophenes; C047508:rotigotine