Objective: To assess whether compulsive sexual behaviour in individuals with PD is associated with higher doses of levodopa.

Background: The lifetime prevalence of compulsive sexual behaviour in PD is estimated to be 2.7%. In patients using dopamine agonists (DA) this number rises to 7.4%. Male gender, earlier PD onset, younger age and higher doses of DA are recognised risk factors. (1)

Methods: Patients with ICBs were seen at the National Hospital for Neurology and Neurosurgery, London, UK during 2005-2016. All patients were screened for the presence of impulsive compulsive behaviours and the hospital notes were reviewed by a movement disorder specialist for clinical, demographic and treatment data when ICBs were most active.

Results: 128 PD patients with ICBs were identified. Seventeen cases were excluded because the data on dopaminergic treatment was incomplete. The remaining 111 patients were divided in two groups based on the presence or absence of hypersexuality: HS+ (N = 55) and HS- (N = 56). Age at PD onset and PD duration until development of ICBs did not differ between groups. There was a male predominance in the hypersexuality group (HS- 60.7%; HS+ 94.5%; p < 0.001). Patients with hypersexuality were younger when ICBs emerged (HS- 59.16 years; HS+ 54.62; p = 0.02). More than one ICB  was present in 48.2% of individuals without and 76.36% of individuals with compulsive sexual behaviour (p = 0.002). A similar number of individuals in both groups were using levodopa (HS- 91%; HS+ 98.18%; p = 0.206), dopamine agonists (HS- 89.2%; HS+ 94.54%; p = 0.48) and MAO inhibitors (HS- 26.7%; HS+ 36.3%; p = 0.312). Levodopa equivalent daily dose (LEDD) was calculated as previously described. (2) Total LEDD (HS- 1163.6; HS+ 1400.15; p = 0.014) and levodopa daily dose (HS- 704.93; HS+ 994.51; p = 0.043) were significantly higher in the HS+ group, whereas DA LEDD did not differ between groups (HS- 357.86; HS+ 385; p = 0.802).

Conclusions: Our study confirms that compulsive sexual behaviour is more frequently seen in male PD patients. Furthermore, compulsive sexual behaviour emerged earlier and was associated with higher doses of levodopa compared to other ICBs. Finally, multiple ICBs are frequently seen in all patients with behavioural addictions but seem to be particularly common in PD patients with compulsive sexual disorder suggesting that treatment strategies may be even more challenging in this subgroup of patients.

References: 1.    Nakum S, Cavanna AE. The prevalence and clinical characteristics of hypersexuality in patients with Parkinson’s disease following dopaminergic therapy: A systematic literature review. Parkinsonism & related disorders. 2016;25:10-6. doi: 10.1016/j.parkreldis.2016.02.017. PubMed PMID: 26923525.
2.    Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE. Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 2010;25(15):2649-2653.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/compulsive-sexual-behaviour-in-parkinsons-disease-is-associated-with-higher-doses-of-levodopa/