Objective: Here we report the case of a 49-year-old man with a 19 years history of PD presenting DDS while he was on LCIG therapy.

Background: Dopaminergic replacement therapy (DRT) often overactivates the dopaminergic circuits involved in reward-orientated and novelty-seeking behavior, leading to development of impulsive – compulsive disorders. The pathological overuse of Parkinson’s disease (PD) medication (DDS) has been linked to the assumption of levodopa and apomorphine.

Methods: The patient has been on levodopa therapy more than 17 years. He developed severe motor fluctuations since 2003 and DDS since 2008. His daily levodopa dose varied between 2500 – 3000 mg in a random way. No other antiParkinsonian drug was taken.We had difficulties with peroral treatment, so we tested him for LCIG therapy in 2013 – with success. After conversion to LCIG infusion the levodopa dose could be reduced /2000 mg / casette/day/ and the symptoms of DDS gradually disappeared. His motor performance was stable without motor and non-motor fluctuations. Two years after initiation of LCIG treatment he began to overuse the levodopa gel, he consumed even 2 casettes daily, finally the casettes were empty until noon (from 6.00 a.m.). Being short of levodopa gel he took about 2000 mg oral levodopa daily in addition. He had to be admitted to a psychiatric department because of severe disturbing dyskinesias and psychiatric problems: anxiety, hallucinations, desorientation, decreased insight. Combined pharmaceutical and cognitive behavioral therapy /CBT/ has been introduced over 8 weeks with hospitalization, and further 8 following weeks in outpatient care. The LCIG therapy was maintained, the peroral medication was gradually withdrawn. Finally the patient got one casette of LCIG /2000 mg levodopa/ and no other antiParkinsonian drug was given.

Results: The symptoms of DDS were eliminated by the end of the fourth week. The continuous CBT and care resulted a stable mental and physical condition.

Conclusions: LCIG therapy should be taken into account even when considering the treatment possibilities of DDS. A successful outcome may be reached without interrupting the LCIG infusion therapy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dopamine-dysregulation-syndrome-dds-in-lcig-infusion-successful-treatment-without-interrupting-the-pump-therapy/