Treatment of ICDs
The main treatment for ICDs is stopping drug therapy or dose reduction, Dr. Weintraub suggested. “Deep brain stimulation (DBS) — which can lead to dose reduction — psychopharmacology (antidepressants, naltrexone), and psychotherapy (cognitive behavioral therapy), may all be beneficial,” he said.
The majority of patients with PD who take DAs or levodopa do not go on to develop ICDs, and the dopaminergic effects may not appear immediately in patients who do, so monitoring is an important part of PD therapeutic management. The potential for ICDs is generally not discussed early in the course of PD, Dr Weintraub explained, but usually comes up later, after treatment is initiated. “A patient really should be notified of the possibility of developing an ICD before initiating any dopaminergic treatment for PD, particularly dopamine agonists,” he said. “And then it should be asked about at all clinical visits, as ICDs can have their onset years after initiating treatment.”
- Weintraub D, David AS, Evans AH, et al. Clinical spectrum of impulse control disorders in Parkinson’s disease. Mov Disord. 2015;30:121-127.
- Voon V, Napier TC, Frank MJ, et al. Impulse control disorders and levodopa-induced dyskinesias in Parkinson’s disease: an update. Lancet Neurol. 2017;16:238-250.
- Zhang G, Zhang Z, Liu L, et al. Impulsive and compulsive behaviors in Parkinson’s disease. Front Aging Neurosci. 2014;6:318.
- Weintraub D, Nirenberg MJ. Impulse control and related disorders in Parkinson’s disease. Neurodegener Dis. 2013;11:63-71.
- Weintraub D, Koester J, Potenza MN, et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients. Arch Neurol. 2010; 67: 589–95.
- Antonini A, Barone P, Bonuccelli U, et al. ICARUS study: prevalence and clinical features of impulse control disorders in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2017;88:317-324.
- Vela L, Martinez Castrillo JC, Garcia Ruiz P, et al. The high prevalence of impulse control behaviors in patients with early-onset Parkinson’s disease: A cross-sectional multicenter study. J Neurol Sci. 2016;368:150-154.
- Goldman JG. Neuropsychiatric issues in Parkinson disease. Continuum. 2016;22:1086-1103.
- Diederich NJ, Goldman JG, Stebbins GT, et al. Failing as doorman and disc jockey at the same time; amygdala dysfunction in parkinson’s disease. Mov Disord. 2016;3:11-22.
- Janek PH, Tye KM. From circuits to behavior in the amygdala. Nature. 2015:517:284-292.
- Pape HC, GABAergic neurons; gate masters of the amygdala, mastered by dopamine. Neuron. 2005;48:877-879.
- Delaveau P, Salgado-Pineda P, Micallef-Roll J, et al. Amygdala activation, modulated by levodopa during emotional recognition processing in healthy volunteers: a double-blind, placebo-controlled study. J Clin Psychopharmacol. 2007;27:692-697.
- Biundo R, Weis L, Facchini S, Formento-Dojot P, et al. Patterns of cortical thickness associated with impulse control disorders in Parkinson’s disease. Mov Disord. 2015;30:688-695.
This article originally appeared on Neurology Advisor