Chronic dopaminergic stimulation in Parkinson's disease: from dyskinesias to impulse control disorders

Lancet Neurol. 2009 Dec;8(12):1140-9. doi: 10.1016/S1474-4422(09)70287-X.

Abstract

Dopamine is an essential neurotransmitter for many brain functions, and its dysfunction has been implicated in both neurological and psychiatric disorders. Parkinson's disease is an archetypal disorder of dopamine dysfunction characterised by motor, cognitive, behavioural, and autonomic symptoms. While effective for motor symptoms, dopamine replacement therapy is associated not only with motor side-effects, such as levodopa-induced dyskinesia, but also behavioural side-effects such as impulse control disorders (eg, pathological gambling and shopping, binge eating, and hypersexuality), punding (ie, abnormal repetitive non-goal oriented behaviours), and compulsive medication use. We review clinical features, overlapping molecular mechanisms, and a specific cognitive mechanism of habit learning that might underlie these behaviours. We integrate these mechanisms with the emerging view of the basal ganglia as a distributive system involved in the selection and facilitation of movements, acts, and emotions.

Publication types

  • Review

MeSH terms

  • Antiparkinson Agents / adverse effects*
  • Antiparkinson Agents / therapeutic use
  • Automatism / physiopathology
  • Compulsive Behavior / chemically induced
  • Compulsive Behavior / psychology
  • Disruptive, Impulse Control, and Conduct Disorders / chemically induced*
  • Disruptive, Impulse Control, and Conduct Disorders / physiopathology
  • Dopamine / physiology*
  • Dopamine Agents / adverse effects*
  • Dopamine Agents / therapeutic use
  • Dyskinesia, Drug-Induced / physiopathology*
  • Gambling / psychology
  • Humans
  • Levodopa / adverse effects*
  • Levodopa / therapeutic use
  • Parkinson Disease / complications*
  • Parkinson Disease / drug therapy
  • Parkinson Disease / psychology
  • Psychoses, Substance-Induced / psychology
  • Sexual Behavior

Substances

  • Antiparkinson Agents
  • Dopamine Agents
  • Levodopa
  • Dopamine