4 years ago

Psychostimulant effect of dopaminergic treatment and addictions in Parkinson's disease

Stéphane Thobois, Amélie Bichon, Valérie Fraix, Eugénie Lhommée, Paul Krack, Benoit Delpont, Jean-Louis Quesada, Christian Lüscher, Sébastien Carnicella, Hélène Klinger, Pierre Pélissier, Pierre Pollak, Anna Castrioto, Emmanuelle Schmitt, Andrea Kistner, Emmanuel Broussolle
Background: Dopamine replacement therapy in PD has been associated with both behavioral addictions and dopamine addiction. Objectives: To investigate potential association between l-dopa induced neuropsychiatric fluctuations and addictions in PD. Methods: A cohort of 102 patients with PD suffering from motor complications of l-dopa treatment was prospectively analyzed. We evaluated dopamine addiction, behavioral addictions, and neuropsychiatric fluctuations using the Ardouin scale of behavior in PD. Results: Patients with (n = 51) or without (n = 51) neuropsychiatric fluctuations did not differ in age, disease duration, medication, or UPDRS III motor score during on and off drug condition. Patients with neuropsychiatric fluctuations had a higher H & Y stage in off-drug condition. A multivariate model showed that dopamine addiction (odds ratio: 8.9; P = 0.02) and behavioral addictions (odds ratio: 3.76; P = 0.033) were more frequent in the presence of neuropsychiatric fluctuations. Behavioral addictions and dopamine addiction were more frequent in the presence than in the absence of on-drug euphoria (46% vs. 13.9%; P < 0.001 and 27% vs 6.2 %; P = 0.003), while conversely, no association emerged between dopamine or behavioral addictions and presence of off-drug dysphoria. Patients with neuropsychiatric fluctuations had a poorer quality of life and a more frequent history of anxiety disorder. Conclusions: The psychostimulant effects of dopamine treatment during on-drug euphoria, rather than avoidance of off-drug dysphoria, appear to drive both behavioral addictions and abuse of medication. © 2017 International Parkinson and Movement Disorder Society

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/mds.27101

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