Objective: To identify risk factors in the development of DAWS in patients with Parkinson’s disease (PD).

Background: DAWS is often a severe, stereotyped cluster of physical and psychological symptoms associated with dopamine agonist withdrawal, causing significant distress. Symptoms include panic attacks, depression, diaphoresis, agitation, fatigue, pain, drug cravings, nausea or orthostatic hypotension. There is not standard treatment other than restarting the dopamine agonist. There are scarce reports regarding risk factors in the development of DAWS.

Methods: We conducted a retrospective chart review of PD patients treated with dopamine agonist who had partial or complete withdrawal from the dopamine agonist. We applied the diagnostic criteria proposed by Rabinak and Niremberg for DAWS. Patients were analyzed according to demographic and treatment specific variables such as PD duration, adverse effects and time of exposure to dopamine agonist, total daily dopaminergic burden and dopamine agonist dose based on levodopa equivalents (LEDD), and history of DBS.

Results: 313 PD patients treated with dopamine agonist between January 2011 and December 2012 were reviewed. 125 patients were discontinued from dopamine agonist for a variety of reasons. Twenty one (16.8%) out of 125 patients fulfilled the diagnostic criteria for DAWS. The demographic characteristics were similar characteristics between patients with and without DAWS. Patients on doses of dopamine agonist ≥150mg LEDD per day had a higher risk of developing DAWS (OR 5.3; p=0.015; CI=95%). Patients who experienced impulse control disorders (ICD) also had a higher incidence of DAWS (OR 5.2; p=0.003; CI=95%), compared to those who developed other side effects from dopamine agonists. Interestingly, history of DBS showed the highest association with DAWS (OR 12.9; p= 0.010; CI=95%).

Conclusions: Our data suggest that the most significant risk factors leading for DAWS are doses of dopamine agonist ≥150mg LEDD per day, presence of ICD as an adverse effect to dopamine agonist and history DBS. The coexistence of these three factors predicted a 92% risk of developing DAWS. Prospective studies are warranted to confirm these findings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/higher-doses-of-dopamine-agonists-impulse-control-disorders-and-history-of-deep-brain-stimulation-dbs-risk-factors-for-dopamine-agonists-withdrawal-syndrome-daws/