Movement Disorders Parkinson’s Disease

The emergence of the behavioral syndrome known as impulse control disorder (ICD) in Parkinson’s disease (PD) has increasingly been associated with dopamine agonist (DAA) use. Clinical reports emphasize the presence of excessive, disruptive, and ‘atypical’ behaviors in PD patients that resolve after discontinuation or reductions of DAA therapy. The severity of these behaviors has resulted in a heightened clinical vigilance, especially in patients prescribed DAA. This review will discuss the historical rationale for the clinical use of DAA in PD, highlighting the increased association of ICD in patients prescribed DAA therapy. The association between DAA and the emergence of ICD supports the hypothesis that altered mesocorticolimbic function, further emphasized in behavioral and imaging studies, may account for the distinct compulsive hedonic behaviors that characterize the clinical features of this disorder. While the first-line treatment option is reduction and discontinuation of DAA therapy, other therapeutic options are discussed.