Leonardo Rigon, Carmelo Fogliano, K Ray Chaudhuri, Karolina Poplawska-Domaszewicz, Cristian Falup-Pecurariu, Iulia Murasan, Mirjam Wolfschlag, Per Odin, Angelo Antonini
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引用次数: 0
Abstract
Introduction: Impulse control and related behavioral disorders (ICBDs) commonly complicate Parkinson's disease (PD) course. The ICBDs spectrum encompasses two groups of conditions, with distinct pathophysiology: proper 'impulse control disorders (ICDs)' (e.g. gambling) and the 'ICDs related disorders (ICDs-RD)' (e.g. punding). Behavioral disturbances are associated with dopamine replacement therapies. ICBDs affect quality of life of patients and caregivers, making their management essential for reducing PD overall burden.
Areas covered: This article reviews current management strategies for ICBDs in PD. The authors highlight strengths and limitations of these strategies, and explore the potential role of emerging treatment options, giving particular focus to new compounds and invasive therapies.
Expert opinion: Prevention, close monitoring, and caregiver involvement are essential in managing ICBDs in PD. Treatment approaches should be tailored to ICBDs' functional impact and aimed to reduce the pulsatile stimulation of dopamine receptors, especially D2. Dopamine agonist (DA) tapering remains the primary therapeutic approach, alongside psychotherapy and second-line agents, like atypical antipsychotics and serotonin-noradrenaline reuptake inhibitors. Insights into ICDs pathophysiology and DA-specific pharmacodynamics indicate safer profiles for certain preparations (e.g. rotigotine patches) and possibly for D1/D5 agonists like tavapadon. Invasive treatments, including deep brain stimulation and infusion therapies, should be prioritized in advanced-stage PD complicated by ICBDs.
期刊介绍：
Expert Review of Neurotherapeutics (ISSN 1473-7175) provides expert reviews on the use of drugs and medicines in clinical neurology and neuropsychiatry. Coverage includes disease management, new medicines and drugs in neurology, therapeutic indications, diagnostics, medical treatment guidelines and neurological diseases such as stroke, epilepsy, Alzheimer''s and Parkinson''s.
Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections:
Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results
Article Highlights – an executive summary of the author’s most critical points
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