Treatment of juvenile parkinson disease and the recurrent emergence of pathologic gambling

• Published in: Cognitive and behavioral neurology Vol. 20; no. 1; pp. 11 - 14
• Main Authors: FERREIRA GARCIA, Rafael, ORDACGI, Lidia, MENDLOWICZ, Mauro V, DE FREITAS, Gabriel R, ROSSO, Ana Lucia Z, NAZAR, Bruno P, FONTENELLE, Leonardo F
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Willkins 01-03-2007
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Antiparkinson Agents - adverse effects; Antiparkinson Agents - therapeutic use; Benzothiazoles - adverse effects; Benzothiazoles - therapeutic use; Biological and medical sciences; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Disruptive, Impulse Control, and Conduct Disorders - chemically induced; Disruptive, Impulse Control, and Conduct Disorders - psychology; Dopamine Agonists - adverse effects; Dopamine Agonists - therapeutic use; Female; Gambling - psychology; Humans; Levodopa - therapeutic use; Medical sciences; Miscellaneous; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Organic mental disorders. Neuropsychology; Parkinsonian Disorders - complications; Parkinsonian Disorders - drug therapy; Parkinsonian Disorders - psychology; Pergolide - adverse effects; Pergolide - therapeutic use; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Recurrence; Human; Nervous system diseases; Relapse; Impulse control disorder; drug therapy; Parkinson disease; Pharmacotherapy; gambling; Antiparkinson agent; Cerebral disorder; Pathological gambling; Chemotherapy; antiparkinson agents; Treatment; Central nervous system disease; adverse effects; impulse control disorders; Degenerative disease; Extrapyramidal syndrome
• ISSN: 1543-3633; 1543-3641
• DOI: 10.1097/wnn.0b013e31802b6c34

To describe the recurrent emergence of pathologic gambling (PG) during the sequential treatment of a patient with Juvenile Parkinson disease (PD) with different dopamine agonists.
Single case report.
A patient with Juvenile PD developed PG soon after beginning treatment with pergolide, a mixed D1/D2 dopamine agonist that is also supposed to exhibit D3 activity. This behavior remitted upon the discontinuation of the drug. A subsequent therapeutic trial with pramipexole, a dopamine agonist with preferential D3 dopamine receptor activity, resulted in the recurrence of PG. Remarkably, previous treatment with levodopa was not associated with this side effect.
These findings seem to confirm previous suggestions that dopaminergic hyperactivity plays an important role in the pathogenesis of PG. They further indicate that patients with PD may develop PG as a side effect of more than one dopamine agonist. There is still no consensus regarding the best strategy to deal with this potentially disturbing phenomenon.