Dopamine dysregulation syndrome (DDS)

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/