Impulse Control Disorders in Parkinson's Disease: Seeking a Roadmap Toward a Better Understanding

Brain Struct Funct. 2011 Nov;216(4):289-99. doi: 10.1007/s00429-011-0314-0. Epub 2011 May 4.

Abstract

The development of an impulse control disorder (ICD) is now recognized as a potential nonmotor adverse effect of dopamine replacement therapy in Parkinson's disease (PD). Here, recent epidemiological, neurophysiological and genetic advances are summarized to outline potential mechanisms involved. It is safe to say that dopaminergic drugs, particularly dopamine agonists, are able to induce ICDs only in a minority of patients, while the majority are somehow protected from this adverse effect. While it seems clear that men with early-onset PD are more vulnerable, other predisposing factors, such as various current or pre-PD personality traits, are a matter of debate. In terms of neurophysiological advances, one may find striking analogies to the addiction literature suggesting a causal chain beginning with certain predisposing conditions of striatal dopamine synapses, an "unnatural" increase of dopamine stimulation and a characteristic pattern of resulting functional changes in remote networks of appetitive drive and impulse control. Future prospects include potential add-on medications and the possible identification of genetic predispositions at a genome-wide scale. Functional imaging of pharmacogenetic interactions (imaging pharmacogenomics) may be an important tool on that road.

Publication types

  • Review

MeSH terms

  • Age of Onset
  • Appetitive Behavior / physiology*
  • Disruptive, Impulse Control, and Conduct Disorders / epidemiology
  • Disruptive, Impulse Control, and Conduct Disorders / etiology*
  • Disruptive, Impulse Control, and Conduct Disorders / genetics*
  • Disruptive, Impulse Control, and Conduct Disorders / physiopathology*
  • Dopamine Agonists / adverse effects*
  • Dopamine Agonists / therapeutic use
  • Dose-Response Relationship, Drug
  • Electric Stimulation
  • Humans
  • Male
  • Models, Biological*
  • Neuroimaging
  • Parkinson Disease / drug therapy*
  • Personality
  • Sex Factors
  • Subthalamic Nucleus / drug effects

Substances

  • Dopamine Agonists