Drugs to Control Parkinson’s Tremors May Increase Risk of Impulse Control Disorders

Neurologists reported that drugs commonly prescribed for Parkinson’s disease are associated in some people with impulse control disorders such as pathological gambling and binge eating. The article, “Treatment of impulse control disorders in Parkinson’s disease: Practical considerations and future directions,” was published in the journal Expert Review of Neurotherapeutics.

Impulse control disorders constitute a group of behavioral disorders defined by a failure to resist an impulse, drive, or temptation to perform an act that is harmful to oneself or to others. The most common ICDs observed include pathological gambling (PG) and hypersexuality (HS) in men, and compulsive buying, and binge or compulsive eating in women, although the disorder is more common in men.

One large study determined that about 14 percent of Parkinson’s disease (PD) patients experience at least one ICD. According to the authors, these patients often lack discernment and undervalue the presence and severity of ICDs.

Dopamine agonists like pramipexole (Mirapex) and ropinirole (Requip), which help to control tremors and other Parkinson’s symptoms, are a primary risk factor for ICDs, the study’s authors reported. Other risk factors include younger age, smoking, alcohol abuse, and personality traits such as impulsivity, obsessive-compulsive disorder, depression, and anxiety.

ICD management is difficult and lacks treatment guidelines. One reason for the difficulty is that patients are reluctant to switch, reduce, or discontinue Parkinson’s medications out of concern their tremors might worsen. Patients being taken off dopamine agonists can also experience withdrawal symptoms that include anxiety, panic attacks, depression, irritability, and fatigue.

In the article, doctors at Loyola Medicine and Loyola University Chicago Stritch School of Medicine provided the latest evidence of treatments for ICDs in patients with PD, including non-drug therapies like deep brain stimulation and cognitive behavioral therapy. Medications that may help control ICDs are atypical antipsychotics, antiepileptic drugs, and antidepressants.

Families also play an important role in managing the symptoms, and should be informed about which PD medication can cause ICDs. Any “unexplained absences, changes in routine behaviors, irritability, hiding evidence of the impulse control disorders and monetary consequences” should be reported to physicians, the authors said in a news release.

Parkinson’s disease is a chronic progressive neurodegenerative disorder that affects 1 percent of the population over 60 years of age. PD is characterized by loss of nigrostriatal dopaminergic neurons leading to classical motor symptoms like bradykinesia, rigidity, tremor, and abnormal gait and posture.