Objective: To report a patient with progressive supranuclear palsy (PSP) in whom an impulse control disorder (ICD) was triggered by a dopaminergic therapy.

Background: ICDs are known to be associated with dopaminergic therapies in Parkinson disease (PD). The spectrum of ICDs include pathological gambling, hypersexuality, compulsive shopping and binge eating. ICDs have rarely been reported in atypical parkinsonism including multiple system atrophy and PSP.

Method: Case report

Results: A 64-year-old man presented with generalized bradykinesia and frequent falls for 1.5 years. He was found to have parkinsonism on examination, and diagnosed with “PD”. Levodopa was initiated and increased to 800 mg/day with modest response. Pramipexole was added, and increased to 0.5 mg/day with mild in parkinsonism. Two months after the addition of pramipexole, his wife reported marked worsening of gambling. Of note, he had gambled frequently since teenage. In the past 10 years, he gambled on soccer games with the amount of 200 Thai baht (approximately 6 US dollars) per day. However, after pramipexole, the amount was 10 times greater than the baseline. In addition, he refused to sleep in order to watch the games he gambled on. He ate ice cream every day which was also new, and gained weight significantly. Pramipexole was tapered off. His gambling activities then returned back to his baseline, and he stopped eating ice cream. Evaluation by a movement disorder specialist revealed clinical features of PSP including vertical supranuclear gaze palsy, axial rigidity, growling dysarthria and gunslinger gait.

Conclusion: This patient demonstrated ICD including pathological gambling and compulsive eating associated with the dopamine agonist in PSP.  His ICD symptoms have clear temporal relationship with the initiation of pramipexole, and improved back to the baseline once the medication was discontinued. While uncommonly used in PSP due to poor benefits, dopamine agonists can result in ICD in PSP. Baseline gambling activities in this patient, and frontal behavioral dysfunction in PSP including impulsivity and compulsive behaviors may be predisposing factors. Our patient can provide insights that dopaminergic therapy-related ICDs may be due to shared mechanisms between PD and PSP, given similar phenomenon despite different underlying pathologies between these two disorders.

« Back to 2023 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/impulse-control-disorder-related-to-dopaminergic-therapy-in-progressive-supranuclear-palsy/