Publication: Dopamin replasman tedavisi alan idiopatik parkinson hastalarında dürtü kontrol bozuklukları sıklığı ve bu sendromlarla ilişkili olabilecek risk faktörlerinin belirlenmesi
Abstract
Parkinson hastalarının küçük bir bölümünde dopamin replasman tedavisi (DRT) sırasında impulsif-kompulsif hastalık spektrumda yer alan bir dizi davranışsal bozukluk bildirilmiştir. Bu davranışlar; “dürtü kontrol bozuklukları (DKB)”, “punding” adı verilen amaçsız, ritüalistik stereotipik tekrarlayıcı davranışlar ve kimyasal bağımlılığa benzer şekilde aşırı ilaç kullanımıyla karakterize “dopamin disregülasyon sendromu (DDS)”dur. Bu çalışmada merkezimizde Parkinson hastalığı ile takip edilen 60 hastada DDS ile ilişkili dürtü kontrol ve tekrarlayıcı davranış bozukluğu (DKTDB) sendromları sıklığı araştırıldı ve bu sendromlarla ilişkili olabilecek risk faktörleri belirlenmeye çalışıldı. Marmara Üniversitesi Tıp Fakültesi Nöroloji Hareket Bozuklukları ve Parkinson Hastalığı Polikliniği’nde takipli 60 idiopatik Parkinson hastası ayrıntılı olarak incelendi. Hastalara demografik özelliklerini, hastalık süreleri ve tiplerini, kullandıkları ilaç çeşitlerini ve dozlarını sorgulayan bir anket uygulandı. Tüm hastalara ayrıca QUİP test uygulandı ve sonuçlarına göre DKB ve punding tanıları kondu. Kişilik özellikleri mizaç ve karakter envanteri ile ölçüldü. Hastaların %18.3’ünde DKTDB, %10’unda kompulsif yemek yeme, %6.6’sında hiperseksüalite, %5’inde patolojik kumar oynama, %1.6’sında kompulsif alışveriş %10’unda punding tespit edildi. Dopamin agonisti ile tedavi edilenlerde bu tedaviyi almayanlara göre DKTDB daha fazla görüldü. DKB ile ilgili diğer risk faktörleri ise L-dopa kullanımı, genç yaş, sigara kullanımı ve yenilik arayan kişilik özelliği idi. Hastalık tipi, cinsiyet, hastalık süresi, öyküde diğer psikiyatrik hastalıkların bulunması ile DKB gelişimi arasında bir ilişki saptanmadı. DKB ve punding literatürde genellikle olgu bildirimleri şeklinde yer almaktadır. Büyük hasta gruplarında yapılmış çalışmalar yeterli değildir. Ayrıca hafif olguların gözden kaçması nedeniyle de gerçek prevalansları net olarak bilinmemektedir. Özellikle dopamin replasman tedavisi alan Parkinson hastalarında ortaya çıkan bu sendrom, dikkatli bir gözlem ve sorgulama ile gözden kaçırılmayacaktır. Parkinson hastalığı, dürtü kontrol bozukluğu, punding, dopamin replasman tedavisi
In a small number of patients with Parkinson’s disease (PD), a series of behavioral disorders included within the spectrum of impulsive-compulsive disorders develop under dopamine replacement therapy (DRT). These behaviors are divided into three groups as “impulse control disorders (ICD)”, “punding” which is characterized by aimless, ritualistic stereotypical repetitive behaviors, and “dopamine dysregulation syndrome (DDS)” which is characterized by drug overuse due to chemical addiction. In this study the rate of impulse control and repetitive behavior disorders (ICRBD) that are related to DDS was investigated in 60 patients with idiopathic PD. Additionally, we aimed to determine the risk factors that are related to these syndromes. Sixty idiopathic PD patients were examined in detail in the Movement Disorders and PD outpatient clinic of the Marmara University hospital. An inquiry, which was questioning the demographic characteristics, the duration and types of the disease, types and doses of the drugs which were administrated, has been applied to the patients. Additionally, QUİP test was applied to the patients and ICD and punding syndrome were diagnosed according to the results of the test. Personality characteristics were measured by the temperament and character inventory. We found ICRBDs in the 18.3%, compulsive eating in the 10%, hypersexuality in the 6.6%, pathological gambling in the 5%, compulsive shopping in the 1.6%, and punding in the 10% of the patients. ICRBDs were more common in the patients treated with a dopamin agonist than the patients not taking a dopamin agonist. Additional risk factors that were significantly related to ICRBDs were L-dopa use, younger age, current cigarette smoking and novelty seeking personality. On the other hand the type and duration of the disease, sex, and an existing psychiatric disorder were not related to the existence of ICD. ICD and punding were generally reported as case reports in the literature. Studies which evaluate large patient groups are not sufficient. Additionally, the accurate prevalence of these syndromes is not known because mild cases may be underestimated. These syndromes which generally occur in PD patients taking dopamine replacement therapy may be recognized with careful observation and investigation. Parkinson’s disease, impulse control disorders, punding, dopamine replacement treatment
In a small number of patients with Parkinson’s disease (PD), a series of behavioral disorders included within the spectrum of impulsive-compulsive disorders develop under dopamine replacement therapy (DRT). These behaviors are divided into three groups as “impulse control disorders (ICD)”, “punding” which is characterized by aimless, ritualistic stereotypical repetitive behaviors, and “dopamine dysregulation syndrome (DDS)” which is characterized by drug overuse due to chemical addiction. In this study the rate of impulse control and repetitive behavior disorders (ICRBD) that are related to DDS was investigated in 60 patients with idiopathic PD. Additionally, we aimed to determine the risk factors that are related to these syndromes. Sixty idiopathic PD patients were examined in detail in the Movement Disorders and PD outpatient clinic of the Marmara University hospital. An inquiry, which was questioning the demographic characteristics, the duration and types of the disease, types and doses of the drugs which were administrated, has been applied to the patients. Additionally, QUİP test was applied to the patients and ICD and punding syndrome were diagnosed according to the results of the test. Personality characteristics were measured by the temperament and character inventory. We found ICRBDs in the 18.3%, compulsive eating in the 10%, hypersexuality in the 6.6%, pathological gambling in the 5%, compulsive shopping in the 1.6%, and punding in the 10% of the patients. ICRBDs were more common in the patients treated with a dopamin agonist than the patients not taking a dopamin agonist. Additional risk factors that were significantly related to ICRBDs were L-dopa use, younger age, current cigarette smoking and novelty seeking personality. On the other hand the type and duration of the disease, sex, and an existing psychiatric disorder were not related to the existence of ICD. ICD and punding were generally reported as case reports in the literature. Studies which evaluate large patient groups are not sufficient. Additionally, the accurate prevalence of these syndromes is not known because mild cases may be underestimated. These syndromes which generally occur in PD patients taking dopamine replacement therapy may be recognized with careful observation and investigation. Parkinson’s disease, impulse control disorders, punding, dopamine replacement treatment