August 19, 2013 E-Pearl: Dopamine Dysregulation Syndrome in Parkinson disease

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August 19, 2013

Dopamine dysregulation syndrome is the addictive pattern of dopamine replacement therapy in Parkinson disease patients.  It is a result of neuroadaptation of the nucleus accumbens and its circuitry, leading to compulsive consumption of levodopa to prevent the non-motor offs of anxiety, depressed mood, and fear, despite a robust motor response. Risk factors include young onset, male sex, history of substance abuse, and impulse control issues.  Treatment is difficult, but early surveillance for compulsive behaviors and reducing levodopa doses and adding an antipsychotic are options.


1.  De la Casa-Fages B and Grandas F.   Dopamine Dysregulation Syndrome and Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's disease.  Neurology Research International.  2011.  doi:10.1155/2011/759895

Submitted by Harini Sarva M.D. Fellow in Movement Disorders, Beth Israel Medical Center in New York.

Dr.  Sarva is a junior member of the AAN.  

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