title: 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.
authors.affiliation: a Department of Neurology , Albany Medical College , Albany , NY , USA.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Ramirez-Zamora
authors.affiliation: b Department of Neurosurgery , Albany Medical College , Albany , NY , USA.
authors.forename: Lucy
authors.initials: L
authors.lastname: Gee
authors.affiliation: c Department of Neurological Sciences , University of Vermont College of Medicine , Burlington , VT , USA.
authors.forename: James
authors.initials: J
authors.lastname: Boyd
authors.affiliation: d Department of Neurology , Loyola University Chicago, Stritch School of Medicine, Maguire Center , Maywood , IL , USA.
authors.forename: José
authors.initials: J
authors.lastname: Biller
mesh_terms: D019468:Disease Management; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000188:drug therapy* / Q000209:etiology*; D018491:Dopamine Agonists / Q000627:therapeutic use*; D006801:Humans; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy
chemical_list: D018491:Dopamine Agonists
keywords: Compulsive eating and shopping; Dopamine Dysregulation Syndrome; Hypersexuality; Impulse control disorders; Parkinson’s disease; Pathological gambling; Punding; STN DBS