Hiba Gül Oruc, Buket Tugan Yildiz
Journal of Clinical Practice and Research - 2025;47(5):541-549
INTRODUCTION Parkinson's disease (PD) is a neurodegenerative disease that develops due to neuron loss in the nigrostriatal dopaminergic pathway in the brain and progresses slowly.1 The general treatment recommendations for PD, the treatment of each patient should be adjusted according to individual characteristics.2J Clin Pract Res 2025;47(5):541-549 542 Oruc and Tugan Yildiz. Impulse Control Disorder and Dopamin AgonistsJ Clin Pract Res 2025;47(5):541-549 Dopamine agonists (DA) act on post-synaptic dopaminergic D2 receptors and mimic dopamine.3 The side effects of DAs include leg oedema, orthostatic hypotension, nausea and impulse control disorders (ICD) such as hypersexuality, gambling, over-organization, excessive shopping, and over-eating.4 Dopamine replacement therapy used for PD can lead to behavioral side effects such as ICD. This non-motor side-effect is thought to emerge as a result of the pulsatile stimulation of D3 dopamine receptors (D3R) in the limbic-ventral striatum with dopamine treatment.5 As the disease duration prolongs, there is an increased risk of the development of at least one ICD. Behavioral disorders in this impulsive-compulsive spectrum are seen in PD patients, especially in those with disease onset at a young age, those who use dopaminergic drugs at a high dose, have a history of depression, alcohol, or substance use and those who exhibit personality traits of impulsivity or continually searching for innovation.6,7 The relationship between ICD and the dopaminergic medications used has been determined in several previous studies. This non-motor side-effect is thought to emerge as a result of the pulsatile stimulation of D3R in the limbic-ventral striatum with dopamine treatment.5 The pathogenesis of peak dose dyskinesia and the high rate of association between peak dose dyskinesia and ICD support this mechanism.8 Chronic use of dopaminergic drugs may interfere with the phasic and tonic activity of dopaminergic neurons and develop adaptive mechanisms in receptor and transporter density.9 Animal studies have shown the mechanisms of this adaptation, upregulation, and downregulation of dopamine receptors. Acute pramipexole treatment reduced mean firing activity at dopamine receptors in the ventral tegment.10 Pulsative stimulation of D3R by dopaminergic drugs leads to up-regulation of these receptors, which in turn leads to ICD.8 According to this pathophysiology, it is argued that the use of long-acting DAs leads to less ICD than the use of short-acting DAs.7 However, there are not enough studies in the literature that have compared these two types of DA with respect to ICD development. We aimed to compare short and long-acting DAs with respect to ICD in patients with PD.MATERIALS AND METHODS Patient Population Seventy-five patients who were diagnosed with idiopathic PD according to the United Kingdom Brain Bank criteria11 and followed up in the Kahramanmaraş Sütçü İmam University, Neurology department's outpatient clinic for movement disorders were evaluated between September 2021 and July 2023. All patients gave written informed consent. KSÜ Non-Interventional Clinical Research Ethics Committee approval has been obtained (dated: 14.09.2021). The study was conducted in accordance with the principles of the Declaration of Helsinki. Patients' inclusion criteria; * Use of the same dose of DA for the last 6 months * Age >18 years * No dementia was determined in the clinical evaluation and anamnesis * Patients using levodopa, rasagiline were also included in the study, but they were required to use the same treatment for the last 6 months. Patients'exclusion criteria; * The presence of dementia * Patients receiving device-supported treatment such as deep brain stimulation, apomorphine infusion, Duodopa intestinal gel infusion * Patients on two or three types of DAs. Evaluation of Patients In the first stage of the study, gender, age, education level, duration of PD, drugs used for PD, smoking status, use of Maras powder (smokeless tobacco), alcohol consumption, family history of PD, gambling and drug use, parental consanguinity, and history of head trauma of patients were asked and recorded.
