Objective: N/A

Background: Paraphilia a form of hyper sexuality is a rare complication of dopaminergic drugs used in the treatment of Parkinson’s disease (PD). We describe a case of erotophonophilia manifested by severe sexual acts with fatal outcome.

Methods: Case report. This 55 year old man has a past history of alcohol and cocaine use and depression since age 38. At age 41 he consulted a neurologist for pain in the right arm and dragging of the right leg. He was diagnosed with PD three years later, at which time a DAT-scan showed diminished dopamine transporter density in the basal ganglia left more than right. He refused anti-PD medication, although he still used cocaine, until the age of 48 at which time he was started on rasagiline 1 mg, levodopa 62.5 mg TID and pramipexole 1.5 mg. Approximately 2 years after initiating treatment he developed right-side dyskinesias and his behaviour changed dramatically. He started new hobbies, including photography, obsessively playing with remote control miniature boats, cars and drones.He asked women he encountered in the streets to participate in his photoshoots in his apartment, during which he made inappropriate sexual advances. His cocaine use increased excessively. In addition, his sexual interests changed to include voyeurism, sadism, erotic asphyxiation, and eventually erotophonophilia leading to two deaths and two attempted sexual murders over a period of one year. Erotophonophilia, a sexual paraphilia also referred to as “lust murder” is an aberrant behavior in which individuals derive sexual pleasure and arousal from murdering someone.The patient filmed one of his lust murders. At age 53 he was imprisoned, but his anti-PD medication was not changed.He continued to show sexually inappropriate behaviour towards female guards.

Results: Paraphilias, including pedophilia have been described in PD as a manifestation of impulse control disorder (ICD), caused by anti-PD medication, particularly dopamine agonists, especially in young-onset male PD patients with a past medical history of affect disorders and drug/alcohol abuse. Excessive cocaine use has been described as a trigger or an exacerbating factor in ICD, as noted in this case. This patient’s aberrant and violent behaviour could have been possibly prevented by adjusting dopaminergic treatment.

Conclusions: Young male patients with PD on anti-PD medication, who exhibit ICD should be carefully evaluated for sexual deviant behaviour.

References: Voon V, Napier TC, Frank MJ, et al. Impulse control disorders and levodopa-induced dyskinesias in Parkinson’s disease: an update. Lancet Neurol. 2017;16:238-250. Solla P et al. Paraphilias and paraphilic disorders in Parkinson’s disease: a systematic review of the literature. Mov Disord 2015: 30 (5): 604-613.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/erotophonophilia-and-severe-impulse-control-disorder-in-a-patient-with-parkinsons-disease/