Abstracts
Impulse control disorders (ICD) in Parkinson's disease (PD) have attracted increasing interest. They are characterized by the inability to control the impulse to perform an act that can be detrimental to them or to others. Although dopamine agonists (DA), as a group, have been associated with impulse control disorders (ICD), piribedil has rarely been reported to cause them.
Method
Case reports of six parkinsonian patients on piribedil presenting pathological gambling (PG).
Results
All of the patients presented ICD associated with piribedil use. Two of them received this medication as first treatment and four of them who had developed ICDs secondary to other DA that reappeared with piribedil.
Conclusion
Despite piribedil is commercially available in only a few countries, it should be considered in the differential diagnosis of PG in patients with PD.
impulse control disorders; dopamine agonists; piribedil; pathological gambling
Os distúrbios do controle do impulso (DCI) na doença de Parkinson (DP) têm atraído crescente interesse. Eles são caracterizados pela incapacidade da pessoa em controlar o impulso para realizar um ato que pode ser prejudicial a ela própria ou aos outros. Embora os agonistas dopaminérgicos (AD), como um grupo, têm sido associados com distúrbios do controle do impulso, o piribedil tem sido relatado raramente como causa dos mesmos.
Método
Relatos de seis casos de pacientes parkinsonianos em uso de piribedil apresentando jogo patológico (JP).
Resultados
Todos os pacientes apresentaram DCI com o uso do piribedil. Dois deles receberam piribedil como primeiro tratamento e quatro deles que haviam desenvolvido DCI devido a outro AD, reapresentaram o quadro com piribedil.
Conclusão
Apesar de o piribedil estar disponível comercialmente apenas em alguns países, deveria ser considerado no diagnóstico diferencial de JP em pacientes com DP.
distúrbios do controle do impulso; agonistas dopaminérgicos; piribedil; jogo patológico
Impulse control disorders (ICD) in Parkinson's disease (PD) have attracted
increasing interest. Symptoms include pathological gambling (PG), compulsive eating,
compulsive shopping, and hypersexuality11 Ávila A, Cardona X, Martín-Baranera M, Bello J, Sastre F.
Impulsive and compulsive behaviors in Parkinson's disease: a one-year
follow-up study. J Neurol Sci. 2011;310(1-2):197-201.
http://dx.doi.org/10.1016/j.jns.2011.05.044
https://doi.org/10.1016/j.jns.2011.05.04...
. These four major components of ICD are often associated with
punding, excessive internet use and dopamine dysregulation syndrome, all revealing a
compulsive behavior. The real prevalence of ICD in PD patients on dopamine agonists (DA)
treatment is unknown, but it has been suggested that it could range from 2% to
13.7%22 Voon V, Hassan K, Zurowski M, Duff-Canning S, Souza M, Fox S et al.
Prospective prevalence of pathologic gambling and medication association in
Parkinson disease. Neurology. 2006;66(11):1750-2.
http://dx.doi.org/10.1212/01.wnl.0000218206.20920.4d
https://doi.org/10.1212/01.wnl.000021820...
,33 Voon V, Hassan K, Zurowski M, Souza M, Thomsen T, Fox S et al.
Prevalence of repetitive and reward-seeking behaviors in Parkinson disease.
Neurology. 2006;67(7):1254-7.
http://dx.doi.org/10.1212/01.wnl.0000238503.20816.13
https://doi.org/10.1212/01.wnl.000023850...
,44 Pontone G, Williams JR, Bassett SS, Marsh L. Clinical features
associated with impulse control disorders in Parkinson disease. Neurology.
2006;67(7):1258-61.
http://dx.doi.org/10.1212/01.wnl.0000238401.76928.45
https://doi.org/10.1212/01.wnl.000023840...
,55 Weintraub D, Siderowf AD, Potenza MN, Goveas J, Morales Kh, Duda JE
et al. Association of dopamine agonist use with impulse control disorders in
Parkinson disease. Arch Neurol. 2006;63(7):969-73.
http://dx.doi.org/10.1001/archneur.63.7.969
https://doi.org/10.1001/archneur.63.7.96...
,66 Weintraub D, Koester J, Potenza MN, Siderowf AD, Stacy M, Voon V et
al. Impulse control disorders in Parkinson disease: a cross-sectional study of
3090 patients. Arch Neurol. 2010;67(5):589-95.
http://dx.doi.org/10.1001/archneurol.2010.65
https://doi.org/10.1001/archneurol.2010....
.
Since Molina et al.77 Molina JA, Sáinz-Artiga MJ, Fraile A, Jiménez-Jiménez
FJ, Villanueva C, Ortí-Pareja M et al. Pathologic gambling in
Parkinson's disease: a behavioral manifestation of pharmacologic treatment?
Mov Disord. 2000;15(5):869-72.
http://dx.doi.org/10.1002/1531-8257(200009)15:5<869::AID-MDS1016>3.0.CO;2-I
https://doi.org/10.1002/1531-8257(200009...
reported the
association between the pharmacologic treatment of PD and PG for the first time in 2000,
several reports have since implicated different dopaminergic drugs with ICDs, especially
DA77 Molina JA, Sáinz-Artiga MJ, Fraile A, Jiménez-Jiménez
FJ, Villanueva C, Ortí-Pareja M et al. Pathologic gambling in
Parkinson's disease: a behavioral manifestation of pharmacologic treatment?
Mov Disord. 2000;15(5):869-72.
http://dx.doi.org/10.1002/1531-8257(200009)15:5<869::AID-MDS1016>3.0.CO;2-I
https://doi.org/10.1002/1531-8257(200009...
,88 Gallagher DA, O'Sullivan SS, Evans AH, Lees AJ, Schraq A.
Pathological gambling in Parkinson's disease: risk factors and differences
from dopamine dysregulation: an analysis of published case series. Mov Disord.
2007;22(12):1757-63. http://dx.doi.org/10.1002/mds.21611
https://doi.org/10.1002/mds.21611...
,99 Avanzi M, Baratti M, Cabrini S, Uber E, Brighetti G, Bonfà F.
Prevalence of pathological gambling in patients with Parkinson's disease.
Mov Disord. 2006;21(12):2068-72.
http://dx.doi.org/10.1002/mds.21072
https://doi.org/10.1002/mds.21072...
. However piribedil, a non-ergot derived DA had not been
associated with ICD until 2010 when Tschopp et al. reported 4 PD patients on piribedil
who developed PG1010 Tschopp L, Salazar Z, Gomez Botello MT, Roca CU, Micheli F et al.
Impulse control disorder and piribedil: report of 5 cases. Clin Neuropharmacol.
2010;33(1):11-3. http://dx.doi.org/10.1097/WNF.0b013e3181c4ae2e
https://doi.org/10.1097/WNF.0b013e3181c4...
. Piribedil is
employed in Argentina and several other countries, and has an action on D2 and D3
dopaminergic receptors, α-2 adrenoreceptors antagonism and minimal interaction
with serotonergic receptors. We describe six PD patients presenting on piribedil who
developed PG (Clinical and demographic characteristics, Table).
CASE 1
A 67-year-old man suffering from an acineto-rigid form of PD for eight years and a long history of depression. He was initially put on low doses of pramipexole, which were eventually increased to 4.5 mg/day. After 2 years of treatment he developed PG. Pramipexole was discontinued and carbidopa/levodopa (C/L) 500 mg/day was initiated in association with paroxetine 20 mg/day and psychotherapy. As the response was poor, quetiapine 25 mg/day was added with complete control of the PG. Due to progressive worsening of the rigidity and walking difficulties, piribedil 150 mg/day was added. He presented considerable motor improvement, however he developed severe PG after 23 months of treatment, and piribedil had to be withdrawn. After discontinuation PG disappeared and C/L had to be increased up to 1,250 mg/day to control his motor symptoms.
CASE 2
A 48-year-old woman suffering from PD for 5 years was first put on pramipexol 3 mg/day. She developed compulsive shopping and eating disorders with a weight increase of 15 Kg pramipexole was discontinued and ropinirole started at 6 mg/day associated with paroxetine at 20 mg/day and psychotherapy. As there was no improvement of the ICD, ropinirole had to be stopped. He was put on piribedil 200 mg/day and quetiapine 50 mg/day. However, despite initial improvement after 3 months of treatment she developed PG and hypersexuality. Piribedil was completely stopped and C/L at 250 m/day started while quetiapine was kept at the same dose. The patient improved her ICDs.
CASE 3
A 49-year-old man with PD initially treated with piribedil at 150 mg/day developed PG after 24 months of exposure causing him severe social and familial problems. Piribedil was switched to ropinirole 8 mg/day and psychotherapy was initiated. As his PG did not improve, the DA was stopped and C/L was prescribed at a dose of 1,000 mg/day to control his motor symptoms. The patient experienced little improvement in PG, and refused to receive antidepressants, psychotherapy, or any other medication for his compulsions.
CASE 4
A 65-year-old man suffering from PD for 9 years was initially treated with piribedil at 150 mg/day for 30 months when he developed PG. Piribedil was discontinued and Stalevo 50 mg/tid was added. Stalevo was later changed for C/L at 500 mg/day resulting in good control of his motor symptoms, without PG.
CASE 5
A 67-year-old man suffering from PD for 10 years was initially treated with pramipexole 1.75 mg/day. Five years later, due to progressive worsening, pramipexole was increased to 4.5 mg/day, and Stalevo 50 mg four times/day was added. A year later, he developed irritability, compulsive eating and PG and pramipexole had to be progressively withdrawn. Paroxetine at 20 mg/day and quetiapine at 25 m/day were introduced with the resolution of his PG. As his motor function worsened, piribedil up to 200 mg/day was added with Stalevo 100 mg/tid, stalevo 50 mg/qid, levodopa/benzerazide (L/B) in the fast release formulation 100/25 mg/tid and paroxetine 20 mg/day. The patient stopped quetiapine by himself. Two years later, he developed compulsive eating and PG, piribedil was then stopped with complete resolution of the ICDs. Stalevo, L/B and paroxetine were increased due to worsening of motor symptoms and depression.
CASE 6
A 50-year-old woman suffering from tremor predominant PD for 11 years had been treated with pramipexole in low doses with progressive increases reaching 4 mg/day and L/B, up to 600 mg/day with good control of her parkinsonian symptoms, except for her right hand resting tremor. Three years after the diagnosis was made and while on pramipexole, she developed compulsive eating and shopping disorders. Pramipexole was discontinued and she was put on piribedil at 200 mg/day, however she developed PG, along with hypersexuality, binge eating and compulsive shopping. At the time piribedil was reduced to 100 mg/day and amantadine 300 mg/day was added with no control of the ICDs. A left thalamotomy was performed for the severe right hand resting tremor. As she continued presenting ICDs, piribedil was stopped, and she was put on L/B 500 mg/day, and L/B in the fast release formulation 100/25 mg qid, with a marked improvement in the ICDs.
DISCUSSION
Four of our cases first developed ICD while on other DA, which promptly disappeared after stopping the DA but reappeared when piribedil was added. The other two cases, first manifested ICD (pathological pambling) with piribedil as a first therapy.
Patients with PD who develop ICD, particularly PG, are usually male, have younger PD
age of onset, a personal or family history of alcohol abuse, or a previous history
of ICD. They are generally receiving DA as PD treatment although any
anti-Parkinsonian treatment is liable to trigger ICD1111 Voon V, Thomsen T, Miyasaki JM, Souza M, Shafro A, Fox SH et al.
Factors associated with dopaminergic drug-related pathological gambling in
Parkinson disease. Arch Neurol. 2007;64(2):212-6.
http://dx.doi.org/10.1001/archneur.64.2.212
https://doi.org/10.1001/archneur.64.2.21...
. In addition, the patient’s psychological
profile may have a role as a risk factor since PD patients with ICD have higher
novelty-seeking trait scores as well as impaired planning on the impulsivity
scale1212 Ceravolo R, Frosini D, Rossi C, Bonuccelli U. Impulse control
disorders in Parkinson's disease: definition, epidemiology, risk factors,
neurobiology and management. Parkinsonism Relat Disord. 2009;15 Suppl 4:S111-5.
http://dx.doi.org/10.1016/S1353-8020(09)70847-8
https://doi.org/10.1016/S1353-8020(09)70...
,1313 Isaias IU, Siri C, Cilia R, De Gaspari D, Pezzoli G, Antonini A. The
relationship between impulsivity and impulse control disorders in
Parkinson's disease. Mov Disord. 2008;23(3):411-5.
http://dx.doi.org/10.1002/mds.21872
https://doi.org/10.1002/mds.21872...
. Depression is also considered a
powerful risk factor. Low performance in cognitive tasks exploring frontal function
has also been reported44 Pontone G, Williams JR, Bassett SS, Marsh L. Clinical features
associated with impulse control disorders in Parkinson disease. Neurology.
2006;67(7):1258-61.
http://dx.doi.org/10.1212/01.wnl.0000238401.76928.45
https://doi.org/10.1212/01.wnl.000023840...
,1414 Santangelo G, Vitale C, Trojano L, Verde F, Grossi D, Barone P.
Cognitive dysfunctions and pathological gambling in patients with
Parkinson's disease. Mov Disord. 2009;24(6):899-905.
http://dx.doi.org/10.1002/mds.22472
https://doi.org/10.1002/mds.22472...
. Sometimes ICD are associated with compulsive medication
use, known as hedonistic homeostatic dysregulation or dopamine dysregulation
syndrome, characterized by the increased use of levodopa beyond the doses required
to achieve relief of motor symptoms. This is also associated with a disabling mood
and behavioral changes when anti-Parkinsonian drugs are withdrawn or doses
decreased99 Avanzi M, Baratti M, Cabrini S, Uber E, Brighetti G, Bonfà F.
Prevalence of pathological gambling in patients with Parkinson's disease.
Mov Disord. 2006;21(12):2068-72.
http://dx.doi.org/10.1002/mds.21072
https://doi.org/10.1002/mds.21072...
,1111 Voon V, Thomsen T, Miyasaki JM, Souza M, Shafro A, Fox SH et al.
Factors associated with dopaminergic drug-related pathological gambling in
Parkinson disease. Arch Neurol. 2007;64(2):212-6.
http://dx.doi.org/10.1001/archneur.64.2.212
https://doi.org/10.1001/archneur.64.2.21...
. Occasionally, patients hide
taking extra doses of medication. Perhaps they misunderstand the prescription, thus
the importance to check exactly what they are receiving1515 Giugni JC, Tschopp L, Escalante V, Micheli F. Dose-dependent impulse
control disorders in piribedil overdose. Clin Neuropharmacol. 2012;35(1):49-50.
http://dx.doi.org/10.1097/WNF.0b013e31823d78ab
https://doi.org/10.1097/WNF.0b013e31823d...
. Among the other ICD, PG is described as the most
frequent compulsion, which was the case in our patients1212 Ceravolo R, Frosini D, Rossi C, Bonuccelli U. Impulse control
disorders in Parkinson's disease: definition, epidemiology, risk factors,
neurobiology and management. Parkinsonism Relat Disord. 2009;15 Suppl 4:S111-5.
http://dx.doi.org/10.1016/S1353-8020(09)70847-8
https://doi.org/10.1016/S1353-8020(09)70...
,1616 Kelley BJ, Duker AP, Chiu P. Dopamine agonists and pathologic
behaviors. Parkinson's disease. 2012;2012:ID603631.
http://dx.doi.org/10.1155/2012/603631
https://doi.org/10.1155/2012/603631...
.
There are 5 different dopamine receptors and l-dopa increases the availability of
dopamine in the brain without any known specificity for a dopamine receptor subtype.
However, DA present high affinity for the D3 receptors, and this is the strongest
theory explaining the compulsive behaviors in PD patients. D3 receptor expression is
particularly rich in limbic areas modulating the physiologic and emotional
experience of novelty, reward and risk assessment1616 Kelley BJ, Duker AP, Chiu P. Dopamine agonists and pathologic
behaviors. Parkinson's disease. 2012;2012:ID603631.
http://dx.doi.org/10.1155/2012/603631
https://doi.org/10.1155/2012/603631...
.
The most useful medical strategy in the management of patients with ICD is the
removal of the causal agent. However in some infrequent cases, either changing the
DA or reducing the dose can be useful. Serotonin reuptake inhibitors have a dubious
benefit in ICD, but are useful in the treatment of concomitant depression. Atypical
antipsychotics including clozapine and quetiapine have also been described be
useful1717 Weiss HD, Marsh L. Impulse control disorders and compulsive
behaviors associated with dopaminergic therapies in Parkinson disease. Neurol
Clin Practice. 2012;2(4):267-74.
http://dx.doi.org/10.1212/CPJ.0b013e318278be9b
https://doi.org/10.1212/CPJ.0b013e318278...
,1818 Ferrara JM, Stacy M. Impulse-control disorders in Parkinson's
disease. CNS Spectr. 2008;13(8):690-8.,1919 Raina G, Cersosimo MG, Micheli F. Zoophilia and impulse control
disorder in a patient with Parkinson disease. J Neurology. 2012;259(5):969-70.
http://dx.doi.org/10.1007/s00415-011-6270-z
https://doi.org/10.1007/s00415-011-6270-...
. In addition amantadine has also been used but
it's therapeutic effects remain controversial2020 Thomas A, Bonanni L, Gambi F, Di Iorio A, Onofrj M. Pathological
gambling in Parkinson disease is reduced by amantadine. Ann Neurol.
2010;68(3):400-4. http://dx.doi.org/10.1002/ana.22029
https://doi.org/10.1002/ana.22029...
,2121 Weintraub D, Sohr M, Potenza MN, Siderowf AD, Stacy M, Voon V et al.
Amantadine use associated with impulse control disorders in Parkinson disease in
cross-sectional study. Ann Neurol. 2010;68(6):963-8.
http://dx.doi.org/10.1002/ana.22164
https://doi.org/10.1002/ana.22164...
. Although piribedil is commercially available in a few
countries, there are only two reports1010 Tschopp L, Salazar Z, Gomez Botello MT, Roca CU, Micheli F et al.
Impulse control disorder and piribedil: report of 5 cases. Clin Neuropharmacol.
2010;33(1):11-3. http://dx.doi.org/10.1097/WNF.0b013e3181c4ae2e
https://doi.org/10.1097/WNF.0b013e3181c4...
,1515 Giugni JC, Tschopp L, Escalante V, Micheli F. Dose-dependent impulse
control disorders in piribedil overdose. Clin Neuropharmacol. 2012;35(1):49-50.
http://dx.doi.org/10.1097/WNF.0b013e31823d78ab
https://doi.org/10.1097/WNF.0b013e31823d...
describing the association of ICD with this DA and both
are from Argentina.
Piribedil is currently marketed in 24 countries including Brazil, Venezuela and Argentina in South America, in 3 European countries and the remainder in Central America and Asia.
Side effects include piribedil-induced sleep attacks in PD and non PD cases have been
reported2222 Evidente VG, Esteban RP, Domingo FM, Carbajal LO, Parazo MA.
Piribedil as an adjunct to levodopa in advanced Parkinson's disease: the
Asian experience. Parkinsonism Relat Disord. 2003;10(2):117-21.
http://dx.doi.org/10.1016/S1353-8020(03)00096-8
https://doi.org/10.1016/S1353-8020(03)00...
,2323 Gouraud A, Millaret A, Descotes J, Vial T, French Association of
Regional Pharmacovigilance Centres. Piribedil-induced sleep attacks in patients
without Parkinson disease: a case series. Clin neuropharmacol. 2011;34(3):104-7.
http://dx.doi.org/10.1097/WNF.0b013e31821f0d8b
https://doi.org/10.1097/WNF.0b013e31821f...
,2424 Tan EK. Piribedil-induced sleep attacks in Parkinson's disease.
Fundam Clin Pharmacol. 2003;17(1):117-9.
http://dx.doi.org/10.1046/j.1472-8206.2003.00122.x
https://doi.org/10.1046/j.1472-8206.2003...
. Piribedil is regarded as a useful, well
tolerated, antiparkinsonian agent, which is also effective in symptoms such as
apathy and depression. Curiously piribedil induced ICD have not been reported
elsewhere. In the REGAIN study including four hundred and five early PD patients,
surprisingly ICD was not reported as a side effect2525 Rascol O, Dubois B, Caldas AC, Senn S, Del Signore S, Lees A. Early
piribedil monotherapy of Parkinson's disease: a planned seven-month report
of the REGAIN study. Mov Disord. 2006;21(12):2110-5.
http://dx.doi.org/10.1002/mds.21122
https://doi.org/10.1002/mds.21122...
. In addition another study performed in India included
515 non PD patients with memory disorders and no ICD was reported2626 Hastak SM. Treatment of memory impairment, vertigo and tinnitus in
the elderly with piribedil in an Indian general practice setting. J Indian Med
Assoc. 2003;101(8):500-1.. Other smaller trials in
different Asian countries also failed to report these side effects2222 Evidente VG, Esteban RP, Domingo FM, Carbajal LO, Parazo MA.
Piribedil as an adjunct to levodopa in advanced Parkinson's disease: the
Asian experience. Parkinsonism Relat Disord. 2003;10(2):117-21.
http://dx.doi.org/10.1016/S1353-8020(03)00096-8
https://doi.org/10.1016/S1353-8020(03)00...
. Whether this is just because
these studies were performed before ICD became widely known or not, remains an open
question.Our cases show that piribedil might have a similar risk to cause ICD as
compared with others DA. However more evidence is required to determine its
prevalence.
References
-
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» https://doi.org/10.1016/j.jns.2011.05.044 -
2Voon V, Hassan K, Zurowski M, Duff-Canning S, Souza M, Fox S et al. Prospective prevalence of pathologic gambling and medication association in Parkinson disease. Neurology. 2006;66(11):1750-2. http://dx.doi.org/10.1212/01.wnl.0000218206.20920.4d
» https://doi.org/10.1212/01.wnl.0000218206.20920.4d -
3Voon V, Hassan K, Zurowski M, Souza M, Thomsen T, Fox S et al. Prevalence of repetitive and reward-seeking behaviors in Parkinson disease. Neurology. 2006;67(7):1254-7. http://dx.doi.org/10.1212/01.wnl.0000238503.20816.13
» https://doi.org/10.1212/01.wnl.0000238503.20816.13 -
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» https://doi.org/10.1212/01.wnl.0000238401.76928.45 -
5Weintraub D, Siderowf AD, Potenza MN, Goveas J, Morales Kh, Duda JE et al. Association of dopamine agonist use with impulse control disorders in Parkinson disease. Arch Neurol. 2006;63(7):969-73. http://dx.doi.org/10.1001/archneur.63.7.969
» https://doi.org/10.1001/archneur.63.7.969 -
6Weintraub D, Koester J, Potenza MN, Siderowf AD, Stacy M, Voon V et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients. Arch Neurol. 2010;67(5):589-95. http://dx.doi.org/10.1001/archneurol.2010.65
» https://doi.org/10.1001/archneurol.2010.65 -
7Molina JA, Sáinz-Artiga MJ, Fraile A, Jiménez-Jiménez FJ, Villanueva C, Ortí-Pareja M et al. Pathologic gambling in Parkinson's disease: a behavioral manifestation of pharmacologic treatment? Mov Disord. 2000;15(5):869-72. http://dx.doi.org/10.1002/1531-8257(200009)15:5<869::AID-MDS1016>3.0.CO;2-I
» https://doi.org/10.1002/1531-8257(200009)15:5<869::AID-MDS1016>3.0.CO;2-I -
8Gallagher DA, O'Sullivan SS, Evans AH, Lees AJ, Schraq A. Pathological gambling in Parkinson's disease: risk factors and differences from dopamine dysregulation: an analysis of published case series. Mov Disord. 2007;22(12):1757-63. http://dx.doi.org/10.1002/mds.21611
» https://doi.org/10.1002/mds.21611 -
9Avanzi M, Baratti M, Cabrini S, Uber E, Brighetti G, Bonfà F. Prevalence of pathological gambling in patients with Parkinson's disease. Mov Disord. 2006;21(12):2068-72. http://dx.doi.org/10.1002/mds.21072
» https://doi.org/10.1002/mds.21072 -
10Tschopp L, Salazar Z, Gomez Botello MT, Roca CU, Micheli F et al. Impulse control disorder and piribedil: report of 5 cases. Clin Neuropharmacol. 2010;33(1):11-3. http://dx.doi.org/10.1097/WNF.0b013e3181c4ae2e
» https://doi.org/10.1097/WNF.0b013e3181c4ae2e -
11Voon V, Thomsen T, Miyasaki JM, Souza M, Shafro A, Fox SH et al. Factors associated with dopaminergic drug-related pathological gambling in Parkinson disease. Arch Neurol. 2007;64(2):212-6. http://dx.doi.org/10.1001/archneur.64.2.212
» https://doi.org/10.1001/archneur.64.2.212 -
12Ceravolo R, Frosini D, Rossi C, Bonuccelli U. Impulse control disorders in Parkinson's disease: definition, epidemiology, risk factors, neurobiology and management. Parkinsonism Relat Disord. 2009;15 Suppl 4:S111-5. http://dx.doi.org/10.1016/S1353-8020(09)70847-8
» https://doi.org/10.1016/S1353-8020(09)70847-8 -
13Isaias IU, Siri C, Cilia R, De Gaspari D, Pezzoli G, Antonini A. The relationship between impulsivity and impulse control disorders in Parkinson's disease. Mov Disord. 2008;23(3):411-5. http://dx.doi.org/10.1002/mds.21872
» https://doi.org/10.1002/mds.21872 -
14Santangelo G, Vitale C, Trojano L, Verde F, Grossi D, Barone P. Cognitive dysfunctions and pathological gambling in patients with Parkinson's disease. Mov Disord. 2009;24(6):899-905. http://dx.doi.org/10.1002/mds.22472
» https://doi.org/10.1002/mds.22472 -
15Giugni JC, Tschopp L, Escalante V, Micheli F. Dose-dependent impulse control disorders in piribedil overdose. Clin Neuropharmacol. 2012;35(1):49-50. http://dx.doi.org/10.1097/WNF.0b013e31823d78ab
» https://doi.org/10.1097/WNF.0b013e31823d78ab -
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Publication Dates
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Publication in this collection
Feb 2015
History
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Received
08 Sept 2014 -
Received
16 Oct 2014 -
Accepted
04 Nov 2014