Objective: To present two cases of dopamine dysregulation syndrome (DDS) in patients with Parkinson’s disease (PD) who took extreme measures to access more dopaminergic medication.

Background: DDS could be described as a form of addiction for dopamine, resulting in patients requesting higher doses of dopaminergic medication.

Method: Case reports.

Results: In the first case, a 44-year old man was diagnosed with PD 8 months before we first saw him at our clinic. At that time, his anti-parkinsonian treatment consisted of levocarb 100/25 mg 3.5 tablets at 08:00 and 16:00, as well as 3 tablets at noon and 20:00, for a total of 13 pills per day. He was also taking selegiline 5 mg in the morning. When seen, 2 hours after his morning levocarb dose, he was moderately dyskinetic, yet not aware of the abnormal movements. He reported feeling under-treated, but his Movement Disorder Society Unified Parkinson’s Disease (MDS-UPDRS) part III score was 3. At the end of the encounter, he requested for an increase in his dose of levocarb, which we declined to prescribe him. A few weeks later, the patient filed a complaint with the hospital’s ombudsperson, in which he argued that he was denied proper care.

In the second case, a 67-year old man diagnosed with PD over a decade ago was started on levodopa/carbidopa intestinal gel (LCIG) because of severe motor fluctuations. Prior to being put on LCIG, he was heavily active, exercising for several hours every day. He commented on how LCIG improved his quality of life and his athletic performance, however he would give himself an extra dose coinciding with physical exercise. He also complained of uncomfortable off periods overnight when the LCIG infusion was paused. To our surprise, when we last saw him, he admitted that, rather than taking levocarb tablets overnight, he would rather start a new LCIG cassette, resulting in him using 2 LCIG cassettes per day. When asked how he managed to procure an extra LCIG cassette, he confessed that he was using the cassette of a friend who was previously on LCIG but no longer needed it, as he had undergone deep brain stimulation surgery.

Conclusion: These 2 cases illustrate the determination of some PD patients with DDS to gain access to additional dopaminergic medication. Clinicians should be mindful of the lengths some patients will go through to access additional dopaminergic medication when they suffer from DDS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/two-unusual-cases-of-dopamine-dysregulation-syndrome-in-patients-with-parkinsons-disease/