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Advanced Therapies for the Management of Dopamine Dysregulation Syndrome in Parkinson's Disease
Author(s) -
Sasikumar Sanskriti,
Matta Roberto,
Munhoz Renato P.,
Zurowski Mateusz,
Poon YuYan,
Hodaie Mojgan,
Kalia Suneil K.,
Lozano Andres M.,
Fasano Alfonso
Publication year - 2021
Publication title -
movement disorders clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.754
H-Index - 18
ISSN - 2330-1619
DOI - 10.1002/mdc3.13154
Subject(s) - deep brain stimulation , subthalamic nucleus , medicine , levodopa , parkinson's disease , carbidopa , adverse effect , disease , pediatrics , anesthesia
Background Dopamine Dysregulation Syndrome (DDS) is an adverse non‐motor complication of dopamine replacement therapy in Parkinson's disease. The current literature on this syndrome is limited, and it remains underdiagnosed and challenging to manage. Objective To assess the role of advanced therapies in the management of DDS. Methods We performed a retrospective chart review and identified patients who fit the inclusion criteria for DDS. They were classified according to risk factors that have been identified in the literature, motor and complication scores, intervention (medical or surgical) and outcome. Multivariate analyses were performed to analyze these characteristics. Results Twenty‐seven patients were identified (23 males, mean age of onset: 49 ± 8.8 years). Average levodopa equivalent daily dose was 1916.7 ± 804 mg and a history of impulse control disorders, psychiatric illness, and substance abuse was present in 89%, 70% and 3.7% of the patients, respectively. Overall 81.5% of patients had symptom resolution at follow up, on average 4.8 ± 3.5 years after management, with medication only (7/9), levodopa‐carbidopa intestinal gel (1/3), deep brain stimulation of subthalamic nucleus (10/13), or globus pallidus pars interna (2/2). Reduction of medications occurred with deep brain stimulation of subthalamic nucleus ( P = 0.01) but was associated with a relapse in two patients. Conclusion Although the small sample size of some subgroups limits our ability to draw meaningful conclusions, our results did not suggest superiority of a single treatment option. Advanced therapies including deep brain stimulation can be considered in patients with DDS refractory to conservative measures, but outcome is variable and relapse is possible.