Impulsive and Compulsive Behaviors in Parkinson's Disease:

Parkinson's disease is a common neurodegenerative disease, with a worldwide incidence of about 10-20 in 100,000. Its diagnosis remains clinical, and it requires bradykinesia plus one of the following: Rest tremor, rigidity or postural instability. Dopaminergic therapy including levodopa and dopamine agonists has allowed a reasonable control over the motor symptoms, but it offered no help for the non-motor manifestations. To the contrary, dopaminergic antiparkinson therapy was the most likely culprit in the emergence of a new set of impulse control disorders including:  Pathological gambling, hypersexuality, compulsive shopping, compulsive eating, punding (complex, repetitive, excessive, non-goal oriented behaviors), walkabout, and dopamine dysregulation syndrome. A case series of three main impulse control disorders in Parkinson's disease is presented here with a review of the current thinking regarding diagnosis and treatment.