Repository logo
 

Impulse control disorders and levodopa-induced dyskinesias in Parkinson's disease: an update

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Napier, TC 
Frank, MJ 
Sgambato-Faure, V 
Grace, AA 

Abstract

Dopaminergic medications used in the treatment of patients with Parkinson's disease are associated with motor and non-motor behavioural side-effects, such as dyskinesias and impulse control disorders also known as behavioural addictions. Levodopa-induced dyskinesias occur in up to 80% of patients with Parkinson's after a few years of chronic treatment. Impulse control disorders, including gambling disorder, binge eating disorder, compulsive sexual behaviour, and compulsive shopping occur in about 17% of patients with Parkinson's disease on dopamine agonists. These behaviours reflect the interactions of the dopaminergic medications with the individual's susceptibility, and the underlying neurobiology of Parkinson's disease. Parkinsonian rodent models show enhanced reinforcing effects of chronic dopaminergic medication, and a potential role for individual susceptibility. In patients with Parkinson's disease and impulse control disorders, impairments are observed across subtypes of decisional impulsivity, possibly reflecting uncertainty and the relative balance of rewards and losses. Impairments appear to be more specific to decisional than motor impulsivity, which might reflect differences in ventral and dorsal striatal engagement. Emerging evidence suggests impulse control disorder subtypes have dissociable correlates, which indicate that individual susceptibility predisposes towards the expression of different behavioural subtypes and neurobiological substrates. Therapeutic interventions to treat patients with Parkinson's disease and impulse control disorders have shown efficacy in randomised controlled trials. Large-scale studies are warranted to identify individual risk factors and novel therapeutic targets for these diseases. Mechanisms underlying impulse control disorders and dyskinesias could provide crucial insights into other behavioural symptoms in Parkinson's disease and addictions in the general population.

Description

Keywords

Antiparkinson Agents, Disruptive, Impulse Control, and Conduct Disorders, Dyskinesia, Drug-Induced, Humans, Levodopa, Parkinson Disease

Journal Title

The Lancet Neurology

Conference Name

Journal ISSN

1474-4422
1474-4465

Volume Title

16

Publisher

Elsevier
Sponsorship
Medical Research Council (MR/P008747/1)