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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(11): 989-994
DOI: 10.1590/0004-282X-ANP-2020-0507
Article

Assessment of therapeutic strategies for management of impulse control disorder in Parkinson’s disease

Evaluación de las estrategias terapéuticas en trastornos del control de impulsos en enfermedad de Parkinson
Mayela Rodríguez-Violante 
1   National Institute of Neurology and Neurosurgery, Clinical Neurodegenerative Research Unit, Mexico City, Mexico.
2   National Institute of Neurology and Neurosurgery, Movement Disorder Clinic, Mexico City, Mexico.
,
Yazmín Ríos-Solís 
1   National Institute of Neurology and Neurosurgery, Clinical Neurodegenerative Research Unit, Mexico City, Mexico.
,
Oscar Esquivel-Zapata 
1   National Institute of Neurology and Neurosurgery, Clinical Neurodegenerative Research Unit, Mexico City, Mexico.
,
Fanny Herrera 
1   National Institute of Neurology and Neurosurgery, Clinical Neurodegenerative Research Unit, Mexico City, Mexico.
2   National Institute of Neurology and Neurosurgery, Movement Disorder Clinic, Mexico City, Mexico.
,
Susana López-Alamillo 
1   National Institute of Neurology and Neurosurgery, Clinical Neurodegenerative Research Unit, Mexico City, Mexico.
,
Cynthia Sarabia-Tapia 
1   National Institute of Neurology and Neurosurgery, Clinical Neurodegenerative Research Unit, Mexico City, Mexico.
,
Amin Cervantes-Arriaga 
1   National Institute of Neurology and Neurosurgery, Clinical Neurodegenerative Research Unit, Mexico City, Mexico.
2   National Institute of Neurology and Neurosurgery, Movement Disorder Clinic, Mexico City, Mexico.
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ABSTRACT

Background: Impulse control disorders (ICD) occur frequently in individuals with Parkinson's disease. So far, prevention is the best treatment. Several strategies for its treatment have been suggested, but their frequency of use and benefit have scarcely been explored. Objective: To investigate which strategy is the most commonly used in a real-life setting and its rate of response. Methods: A longitudinal study was conducted. At the baseline evaluation, data on current treatment and ICD status according to QUIP-RS were collected. The treatment strategies were categorized as “no-change”, dopamine agonist (DA) dose lowering, DA removal, DA switch or add-on therapy. At the six-month follow-up visit, the same tools were applied. Results: A total of 132 individuals (58.3% men) were included; 18.2% had at least one ICD at baseline. The therapeutic strategy most used in the ICD group was no-change (37.5%), followed by DA removal (16.7%), DA switch (12.5%) and DA lowering (8.3%). Unexpectedly, in 20.8% of the ICD subjects the DA dose was increased. Overall, nearly 80% of the subjects showed remission of their ICD at follow-up. Conclusions: Regardless of the therapy used, most of the subjects presented remission of their ICD at follow-up Further research with a longer follow-up in a larger sample, with assessment of decision-making processes, is required in order to better understand the efficacy of strategies for ICD treatment.

Resumen

Antecedentes: Los trastornos del control de impulsos (TCI) son frecuentes en personas con enfermedad de Parkinson. A la fecha, la prevención es el mejor tratamiento. Existen varias estrategias sugeridas para su tratamiento, pero su frecuencia de uso y beneficio ha sido escasamente explorada. Objetivo: Investigar qué estrategia es la más utilizada en un entorno de la vida real y su tasa de respuesta. Métodos: Se realizó un estudio longitudinal. En la evaluación inicial, se recopiló el tratamiento actual y el estado del TCI de acuerdo con el QUIP-RS. La estrategia de tratamiento se clasificó como "sin cambios", reducción de la dosis de agonista de la dopamina (AD), eliminación de AD, cambio de AD o terapia complementaria. En la visita de seguimiento a los 6 meses, se aplicaron las mismas herramientas. Resultados: Se incluyeron un total de 132 (58.3% hombres) personas. El 18.2% tenía al menos un TCI al inicio del estudio. La estrategia terapéutica más utilizada en el grupo de TCI fue sin cambios (37.5%), seguida de eliminación de DA (16.7%), cambio de AD (12.5%) y reducción de DA (8.3%). En el 20.8% de los sujetos con TCI se aumentó la dosis de AD. Casi el 80% de los sujetos tuvieron una remisión del TCI al seguimiento. Conclusiones: Independientemente de la terapia utilizada, la mayoría de los sujetos tuvieron una remisión del TCI. Se requiere más investigación con un seguimiento y una muestra mayor para evaluar l proceso de toma de decisiones para comprender mejor la eficacia de las estrategias.

Keywords:

Parkinson Disease - Disruptive, Impulse Control, and Conduct Disorders - Treatment Outcome

Palabras clave:

Enfermedad de Parkinson - Trastornos Disruptivos, del Control de Impulso y de la Conducta - Resultado del Tratamiento

Authors’ contributions:

FH, YRS, SLA, CST: data acquisition; MRV, FH, YRS: study conception and design; OEZ, ACA: data analysis and interpretation; MRV, YRS, OEZ, ACA: drafting, reviewing and final approval of the manuscript.




Publication History

Received: 26 October 2020

Accepted: 13 January 2021

Article published online:
04 July 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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