Objective: To determine characteristics of parkinsonian patients under levodopa/carbidopa intestinal gel (LCIG) infusion who present impulse control disorders (ICDs).

Background: ICDs may be induced by dopamine agonist in patients with Parkinson’s disease, while they have been reported as adverse effects of LCIG infusion (1,2).

Methods: We checked clinometric properties of patients who presented ICDs after initiating LCIG therapy. We also evaluated the clinical symptoms of these patients to examine the possible factors as the cause of ICDs.

Results: Three out of nine patients with Parkinson’s disease presented ICDs after starting LCIG therapy consisting of two men and one woman. One patient developed hypersexuality in two weeks and also pathological shopping one month after starting LCIG. One patient started pathological shopping as well as spending a lot of hours and money on social games one month after starting LCIG. The other patient showed a symptom of hypersexuality three months after starting LCIG. All three patients showed no history of ICDs before starting LCIG infusion. One patients had previous history of depression. All of these patients were cheerful and in hypomanic state presenting more energy than usual. There are no differences of age, disease duration, MMSE score, Hoehn and Yahr staging, UPDRS score, and levodopa equivalent daily dose of anti-parkinsonian drugs between patients under LCIG therapy with and without ICDs. Some of them disappeared as well as hypomanic state, whereas one patient did not improve her hypersexuality.

Conclusions: LCIG therapy may induce ICDs. Some of them could appear in hypomanic state. ICDs which occurred under LCIG therapy may have common mechanism with dopamine dysregulation syndrome.

References: 1. Salomone G, Marano M, di Biase L, et al. Dopamine dysregulation syndrome and punding in levodopa-carbidopa intestinal gel (LCIG) infusion: A serious but preventable complication. Park Relat Disord.2015; 21: 1124-1125. 2. Chang FC, Kwan V, van der Poorten D, et al. Intraduodenal levodopa-carbidopa intestinal gel infusion improves both motor performance and quality of life in advanced Parkinson’s disease. J Clin Neurosci 2016; 25: 41-45.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impulse-control-disorders-could-be-accompanied-by-hypomanic-state-under-intestinal-levodopa-infusion/