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New pharmacological and neuromodulation approaches for impulsive-compulsive behaviors in Parkinson’s disease

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Abstract

Introduction

A significant proportion of patients with Parkinson’s disease (PD) display a set of impulsive-compulsive behaviors at some point during the course of illness. These behaviors range from the so-called behavioral addictions to dopamine dysregulation syndrome, punding and hoarding disorders. These behaviors have been consistently linked to the use of dopaminergic medications used to treat PD motor symptoms (dopamine agonists, levodopa, and other agents) and less consistently to neuromodulation techniques such as deep brain stimulation (DBS). Since there are still no approved treatments for these conditions, their pharmacological management is still a big challenge for clinicians.

Methods

We conducted an extensive review of current pharmacological and neuromodulation literature for the management of impulsive-compulsive disorders in PD patients.

Results

Pharmacological treatment approaches for impulsive-compulsive behaviors and DDS in PD patients include reduction of levodopa (LD), reduction/cessation of dopamine agonist (DA), and initiation of infusion therapies (apomorphine infusion and duodopa). Also, atomoxetine, a noradrenergic agent approved for the treatment of attention deficit hyperactivity disorder, showed some interesting preliminary results but there is still a lack of controlled longitudinal studies. Finally, while DBS effects on impulsive-compulsive disorders are still controversial, non-invasive techniques (such as transcranial magnetic stimulation and transcranial direct current stimulation) could have a potential positive effect but, again, there is still a lack of controlled trials.

Conclusion

Managing impulsivity and compulsivity in PD patients is still a non-evidence-based challenge for clinicians. Controlled trials on promising approaches such as atomoxetine and non-invasive neuromodulation techniques are needed.

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Authors and Affiliations

  1. Brain Center Firenze, Viale Belfiore 36, 5014, Florence, Italy

    Giacomo Grassi & Lorenzo Razzolini

  2. Istituto Auxologico Italiano – IRCCS, Verbania, Italy

    Giovanni Albani

  3. University of Florence, Florence, Italy

    Federica Terenzi & Lorenzo Razzolini

  4. Parkinson Unit, AOU Careggi, Florence, Italy

    Silvia Ramat

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  1. Giacomo Grassi
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  2. Giovanni Albani
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  4. Lorenzo Razzolini
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  5. Silvia Ramat
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GG: conception and design of the paper, drafting, final approval of the version to be submitted; GA: conception and design of the paper, drafting, final approval of the version to be submitted; SR and FT: drafting, final approval of the version to be submitted; LR: revising it critically for important intellectual content, final approval of the version to be submitted

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Grassi, G., Albani, G., Terenzi, F. et al. New pharmacological and neuromodulation approaches for impulsive-compulsive behaviors in Parkinson’s disease. Neurol Sci 42, 2673–2682 (2021). https://doi.org/10.1007/s10072-021-05237-8

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