title: Impulse control disorders in Parkinson's disease: seeking a roadmap toward a better understanding.
abstract: The development of an impulse control disorder (ICD) is now recognized as a potential nonmotor adverse effect of dopamine replacement therapy in Parkinson's disease (PD). Here, recent epidemiological, neurophysiological and genetic advances are summarized to outline potential mechanisms involved. It is safe to say that dopaminergic drugs, particularly dopamine agonists, are able to induce ICDs only in a minority of patients, while the majority are somehow protected from this adverse effect. While it seems clear that men with early-onset PD are more vulnerable, other predisposing factors, such as various current or pre-PD personality traits, are a matter of debate. In terms of neurophysiological advances, one may find striking analogies to the addiction literature suggesting a causal chain beginning with certain predisposing conditions of striatal dopamine synapses, an "unnatural" increase of dopamine stimulation and a characteristic pattern of resulting functional changes in remote networks of appetitive drive and impulse control. Future prospects include potential add-on medications and the possible identification of genetic predispositions at a genome-wide scale. Functional imaging of pharmacogenetic interactions (imaging pharmacogenomics) may be an important tool on that road.
authors.affiliation: Parkinson Institute, Istituti Clinici di Perfezionamento, via Bignami 1, 20126 Milan, Italy. roberto.cilia@gmail.com
authors.forename: Roberto
authors.initials: R
authors.lastname: Cilia
authors.forename: Thilo
authors.initials: T
authors.lastname: van Eimeren
mesh_terms: D017668:Age of Onset; D001070:Appetitive Behavior / Q000502:physiology*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics* / Q000503:physiopathology*; D018491:Dopamine Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004558:Electric Stimulation; D006801:Humans; D008297:Male; D008954:Models, Biological; D059906:Neuroimaging; D010300:Parkinson Disease / Q000188:drug therapy*; D010551:Personality; D012737:Sex Factors; D020531:Subthalamic Nucleus / Q000187:drug effects
chemical_list: D018491:Dopamine Agonists