Troubles du contrôle des impulsions associés à la maladie de Parkinson : étude d’une cohorte de 35 patients

Abstract

Impulse control disorders (ICDs) in Parkinson's disease (PD) are associated with dopamine agonist treatment. Although discontinuation of dopamine agonist is recommended, ICD management has not been precisely stated. The aims of the study were to describe demographic and clinical characteristics in a group of PD patients with ICDs and to evaluate the management of dopamine agonist treatment proposed to the same patients in order to treat the ICDs. Thirty-five PD patients with ICD and 607PD patients without ICD were studied. In the ICD group, demographic and clinical data were collected prospectively (ICD characteristics, motor and cognitive evaluation); demographic and clinical data were obtained retrospectively in the group without ICD. In the ICD group, the sex ratio was 2.9 (versus 1.2in the absence of ICD; p<0.05), the mean age was 57.5years (versus 66.9years; p<0.01) and the mean age at PD onset was 48.3years (versus 55.5years; p<0.01). All ICD patients were receiving a dopamine agonist when the ICD started (versus 50.9% of patients receiving a dopamine agonist in the absence of ICD; p<10(-6)). In mean, ICDs started 2.8years before they were diagnosed. No particular dopamine agonist was associated with ICDs more frequently than the others. Discontinuation of the dopamine agonist was the treatment the more frequently associated with the recovery of ICDs (93.3%). Dose lowering and the change of dopamine agonist resulted in complete regression of ICDs respectively in 9.1% and 33.3% of patients. Young age, male gender and young age at PD onset are frequent in PD patients developing ICDs, as already described in American or Asian cohorts. We highlighted a long diagnosis delay and confirmed the strong efficacy of dopamine agonist withdrawal.