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Journal of Neurology

, 255:48 | Cite as

Parkinson’s disease-related disorders in the impulsive-compulsive spectrum

  • Eric Ch. Wolters
  • Ysbrand D. van der Werf
  • Odile A. van den Heuvel
Article

Abstract

In Parkinson’s disease (PD), there is increasing evidence for disorders in the impulsive-compulsive spectrum, related to the disease itself, to the pharmacological management of this disease or to both. These disorders comprise dopamine deficiency syndrome (with immediate reward seeking behaviour), dopamine dependency syndrome (with addictive behaviour), dopamine dysregulation syndrome (with both addictive behaviour and stereotyped behaviour) and impulse control disorders (such as pathological gambling, compulsive shopping, binge eating and hypersexuality). These disorders are especially seen in PD patients with young age of onset, higher doses of antiparkinsonian drugs, pre-existent or current depression, pre-existing recreational drug or alcohol use, and high novelty seeking personality traits.

Dopamine is not only implicated in voluntary movement control but also plays a significant role in the brain’s reward system and the modulation of behaviours. Therefore, most if not all drugnaïve PD patients will suffer dysphoria, leading to mild immediate reward seeking behaviour as a consequence of the striatal dopaminergic denervation. In some of these patients, during treatment, this may even lead to the intake of increasing quantities of levodopa, above those required to adequately treat motor parkinsonism, with all characteristics of a dopamine dependence syndrome. These patients may develop plastic changes in the striatal matrix leading to hyperkinesia, caused by extracellular striatal dopaminergic fluctuations due to pulsatile dopamine replacement therapy. As soon as these changes are also seen in the striatal striosomes, in the framework of a dopamine dysregulation syndrome, stereotyped behaviours (punding) may occur (supposedly due to dorsal versus ventral striatal overactivity). Finally, impulse control disorders are suggested as being pure adverse side-effects of dopamine replacement therapy. Obsessive-compulsive behaviour (caused by ventral to dorsal overactivity) so far has not been described in PD patients.

Treatment of impulse control disorders is related to the underlying pathology. In the case of an intrinsic dopamine deficiency syndrome, treatment with dopamine replacement therapy, especially levodopa, will help. In the multifactorial (intrinsic and extrinsic) dopamine dependency and dysregulation syndromes, addictive behaviour might best be helped by psychosocial strategies, and punding by continuous dopaminergic receptor stimulation (or amantadine), hypothesized to reduce the plastic changes-induced hypersensitization. The extrinsic impulse control disorders might be best treated by reducing or replacing dopamine receptor agonists.

Key words

dopamine deficiency syndrome dopamine dependency syndrome dopamine dysregulation syndrome impulse control disorders obsessive compulsive behaviour impulsive-compulsive spectrum disorders 

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Copyright information

© Springer 2008

Authors and Affiliations

  • Eric Ch. Wolters
    • 1
  • Ysbrand D. van der Werf
    • 2
    • 3
  • Odile A. van den Heuvel
    • 4
  1. 1.Dept. of NeurologyVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Dept. of Clinical NeurophysiologyVU University Medical CenterAmsterdamThe Netherlands
  3. 3.Dept. Sleep and CognitionNetherlands Institute for Neuroscience an Institute of the Royal Netherlands Academy of Arts and SciencesAmsterdamThe Netherlands
  4. 4.Dept. of Psychiatry and Anatomy & NeurosciencesVU University Medical CenterAmsterdamThe Netherlands

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