title: Behavioral effects of levodopa.
abstract: In recent years, levodopa-induced behavioral changes have received increased attention in the medical literature and in clinical practice. The spectrum of these symptoms includes non-motor fluctuations with neuropsychiatric symptoms, compulsive behaviors such as punding, dopamine dysregulation syndrome, and impulse control disorders, psychosis and hallucinations, as well as hypomania and mania. Despite knowledge of the clinical features associated with these behaviors, many of them are probably underdiagnosed. Although the mechanisms underlying behavioral symptoms are still incompletely understood, recent data from imaging and pathological studies have increased our understanding and guided new treatment strategies. Appropriate management remains challenging, because reduction of levodopa (l-dopa) and dopaminergic treatment is often recommended; however, doses required for control of motor symptoms may still induce behavioral changes. Newer modes of delivery of dopaminergic treatment, deep brain stimulation, and nondopaminergic agents may either provide alternatives for treatment of these behavioral problems or permit treatment of parkinsonism with less risk of these behavioral disorders.
authors.affiliation: Morton & Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Beaulieu-Boire
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Lang
mesh_terms: D000818:Animals; D000978:Antiparkinson Agents / Q000009:adverse effects*; D001526:Behavioral Symptoms / Q000139:chemically induced* / Q000628:therapy; D046690:Deep Brain Stimulation; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D007980:Levodopa / Q000009:adverse effects*; D010300:Parkinson Disease / Q000188:drug therapy
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: Behavioral effects; Dopamine dysregulation; Impulse control; Levodopa; Mania; Parkison's Disease; Psychosis; Punding