Dopamine dysregulation syndrome (DDS)

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Diagnosis

Dopamine dysregulation syndrome (DDS) is an uncommon complication in the treatment of PD, characterized by addictive behavior and excessive use of dopaminergic medication (Warren et al, 2017)

  • prevalence is 3-4% in movement disorder clinics (Warren et al, 2017)
  • can result in impulse control disorders and psychosis (Warren et al, 2017)
  • Clinical characteristics include: (Warren et al, 2017)
    • responsiveness to levodopa (100%)
    • increased dopamine replacement therapy dose used (100%)
    • drug-seeking behavior (91.8%)
    • functional impairment (98%)
    • hypomanic / manic / cyclothymic mood (64.3%)
    • dysthymic / depressed mood (62.2%)
    • anxiety (37.8%)
    • dyskinesias (79.6%)
  • comorbidities include (Warren et al, 2017)
    • punding (21.4%)
    • aggression (17.3%)
    • psychosis (31.6%, mostly delusions)
    • walkabout (11.2%)
    • binge eating (10.2%)
    • gambling (27.6%)
    • hypersexuality (39.8%)
    • compulsive shopping (8.2%)


Treatment (Warren et al, 2017)

  • DRT regime change (improvement in 25/52 cases)
  • Psychological therapy (improvement in 4/7 cases)
  • Electroconvulsive therapy (improvement in 0/1 cases)
  • Antidepressants (improvement in 3/9 cases)
  • Antipsychotics (improvement in 6/11 cases)
  • Valproic acid (improvement in 5/5 cases)
  • Lithium (improvement in 0/2 cases)
  • Levodopa infusion (improvement in 4/8 cases)
  • Apomorphine infusion (improvement in 0/2 cases)
  • Deep brain stimulation (improvement in 7/12 cases)

References

Warren, N., O’Gorman, C., Lehn, A. & Siskind, D. Dopamine dysregulation syndrome in Parkinson’s disease: a systematic review of published cases. J. Neurol. Neurosurg. Psychiatry 88, 1060–1064 (2017). https://pubmed.ncbi.nlm.nih.gov/29018160/