Objective: The aims of this study was to determine the frequency of Dopamine agonist (DA) withdrawal syndrome (DAWS) in a sample of Sardinian patients with Parkinson’s disease (PD).

Background: DAWS is a complication that affects PD patients. DAWS is defined as a severe, stereotyped cluster of physical and psychological symptoms related to DA tapering, Although DAWS may cause clinically significant distress or social/occupational dysfunction, it is scarcely investigated. Currently there are no standard treatments for this disorder, whilst early recognition of risk factors appears significant for its prevention.

Method: 278 (169 male) PD patients outpatients on DA treatment from the Movement Disorders Center of the University of Cagliari were included in the study. DAWS diagnosis was made according with proposed criteria of Rabinak e Niremberg1. All the causes of DA reduction/suspension was registered. Presence of impulse control disorders (ICDs), dopamine dysregulation syndrome, and other behavioral/neuropsychiatric disorders was also investigated. Levodopa Equivalent Daily Dose (LEDD) was registered.

Results: Mean age of the sample was 69.4±8.6 years. Mean disease duration was 8.9 ± 5.5. Among different DAs, 165 patients (59.3%) were on pramipexole, 73 patients (26.3%) were on rotigotine, and 64 patients (23.0%) were receiving ropinirole. 22 patients (7.9%) were on treatment with more DAs. Of these 278 subjects treated with a DA, 111 underwent subsequent DA reduction/suspension (39,93%). Among causes of DA reduction/suspension, the most important was the presence of ICDs (26.1%), followed by psychoses (22,5%). Among these 111 subjects, 10 (9%) developed DAWS. Only 4 subjects with DAWS had baseline DA-related ICDs, while the remaining 6 patients did not have a history of ICDs. DAWS development was mainly related to DA dosage before the suspension (280,5 ± 84 mg in patients with DAWS vs 109,2 ± 113 mg in patients without DAWS, p<0,001).

Conclusion: DAWS represents a possible psychiatric-behavioral complication in PD patients, although often not adequately investigated. Physicians should assess and contol patients closely when tapering DAs to prevent this disabling syndrome.

References: 1) Rabinak CA, Nirenberg MJ. Dopamine agonist withdrawal syndrome in Parkinson disease. Arch Neurol. 2010 Jan;67(1):58-63.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dopamine-agonist-withdrawal-syndrome-in-sardinian-patients-affected-by-parkinsons-disease/