Objective: To study four cases of maladaptive use of levodopa/carbidopa (LD/CD) as painkillers causing Dopamine dysregulation syndrome (DDS) in Parkinson’s disease (PD) patient in a North Indian tertiary-care hospital.

Background: Dopamine dysregulation syndrome is a well known side effect of long term LD/CD use in PD through its commonly seen signs such as pathological gambling, compulsive shopping, hypersexuality and Impulse-control behavior disorder[1]. It manifests in some by increased drug intake akin to drug addiction causing severe financial crisis, hoarding and stealing[2]. In this abstract we would like to discuss cases of 4 such patients who developed maladaptive use of LD/CD as painkillers for their dystonic pain, a lesser known manifestation of DDS[table1].

Method: Four cases of LD/CD maladaptive-use as painkillers were studied in detail to understand the various symptoms associated with LD/CD use-dependence. Symptoms of all four cases were evaluated according to UPDRS, QUIP-RS, Work and social adjustment scale (WSAS), pain disability questionnaire (PDQ) and Burke-Fahn-Marsen dystonia rating scales[table2].

Results: Patients exhibited maladaptive-use by consuming doses higher than clinically necessary mainly for dystonic-pain relief but also experienced other positive symptoms i.e., euphoria, punding, salience, and autonomic-dysfunction. Despite troublesome on-period symptoms such as impulse-control disorder (ICD), hallucinations, psychosis, aggression, on-period dystonia the patients did not limit their drug use. Their maladaptive-use pattern (hoarding, running out of monthly medication ration sooner or persistently asking for more) was identified by primary care-givers and reported to the physician. Only two patients had a history of Substance-use disorder.

Conclusion: LD/CD use as painkillers is not well reported in studies however talked about in patient forums as a distressing and disabling side-effect[3]. Possible hypothesis could be that LD/CD may trigger the reward center providing euphoria when frequently used as painkiller for relieving dystonic pain thereby causing its maladaptive-use. In a patriarchal society like North India, female patients may not suffer frequently from gambling/compulsive-shopping but instead have symptoms of euphoria, punding, salience and ICD.

References: [1] Schreiber L, Odlaug BL, Grant JE. Impulse control disorders: updated review of clinical characteristics and pharmacological management. Front Psychiatry. 2011;2:1. Published 2011 Feb 21. doi:10.3389/fpsyt.2011.00001 [2] Spigset O., von Scheele C. Levodopa dependence and abuse in Parkinson’s disease. Pharmacotherapy 1997; 17: 1027– 30. [3] (online) https://www.neurotalk.org/parkinson-s-disease/13665-sinemet-addictive-3.html

« Back to MDS Virtual Congress 2020

MDS Abstracts - https://www.mdsabstracts.org/abstract/maladaptive-use-of-ld-cd-tablets-as-painkillers-causing-dopamine-dysregulation-syndrome-in-4-patients-of-advanced-parkinsons-disease/