Dopaminergic agents are used to treat Parkinson's disease (PD), and an increase in impulse-control disorders is a known adverse effect of treatment with these drugs in that setting. These agents are also now commonly prescribed for RLS.
The study showed that "impulse-control disorders are common with the use of dopaminergic agonists [in RLS patients], but discontinuing can often lead to a rapid resolution," Jason Cornelius, MD, a resident in neurology at the Mayo Clinic in Rochester, Minnesota, told attendees here.
The fact that the adverse effects were seen in unrelated conditions such as PD and RLS "supports the theory that it's the medicine rather than the underlying disease that is to blame," Dr. Cornelius added.
He presented the results here at SLEEP 2009: 23rd Annual Meeting of the Associated Professional Sleep Societies.
Survey Results
In this study, the researchers set out to determine the frequency of impulse-control disorders in RLS patients treated with dopaminergic agents. They sent a survey to 3 groups of subjects: 100 patients with RLS who had been treated or were currently being treated with dopaminergic agents; 275 obstructive sleep apnea (OSA) patients who did not have RLS and had not received dopaminergic agents (OSA controls); and 52 RLS patients who had never received dopaminergic drugs (RLS controls).
No patients with PD were included in the study. When respondents indicated the presence of impulse-control disorders on the screening questionnaire, the researchers conducted follow-up telephone interviews to confirm the diagnoses.
RLS patients treated with dopaminergic agents showed an increased incidence of impulse-control disorders compared with the other groups, specifically an increased frequency of compulsive shopping, pathologic gambling, hypersexuality, and punding, which is a fascination with performance of repetitive mechanical tasks such as building small wooden boxes.
The increased frequency was statistically significant for compulsive shopping (P = 0.0002), pathologic gambling (P = 0.006), and punding (P = 0.005) compared with OSA controls. Against RLS controls, they found a statistically significant increase in compulsive shopping (P =0.03) in the RLS patients on dopaminergic agents.
Impulse Control Disorders in RLS Patients Treated with Dopaminergic Agents vs Controls
| End Point | RLS Patients Receiving Dopaminergic Agents (%) | Obstructive Sleep Apnea Controls (%) | RLS Patients Not Treated With Dopaminergic Agents (%) |
| Compulsive shopping | 9 | .07 | 0 |
| Pathologic gambling | 5 | .04 | 2 |
| Hypersexuality | 3 | .04 | 0 |
| Punding | 7 | 1 | 0 |
Eight patients with impulse-control disorders discontinued use of the dopaminergic agents; 7 of the disorders resolved within a few weeks; and the other 1 improved significantly.
"It doesn't mean you don't continue to use these drugs [to treat RLS] . . . but every patient must be warned [of impulse-control disorders and potential adverse effects] and questioned on return visits," Michael Silber, MBchB, professor of neurology at the Mayo Clinic College of Medicine and the study's lead researcher, told Medscape Neurology. "We've seen some devastating complications."
"It's an incredibly important study, but we need to give more specific guidelines to help physicians warn or alert patients — they have to ask to see if [impulse-control disorders] are happening," Richard Allen, PhD, a research associate in neurology at Johns Hopkins Medicine, in Baltimore, Maryland, told Medscape Neurology.
0 comments:
Post a Comment