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Nearly half of patients with Parkinson's disease (PD) who take dopamine agonists (DA) develop 5-year pulse control disorders (DAI). This is demonstrated by a new research published online on "Neurology". The study authors, in particular, found that, in patients with Parkinson's disease, the prevalence of ICDs increased from 19.7% initially to 32.8% at age 5 , with a cumulative incidence of about 46%. 19659002] Nearly half of patients with Parkinson's disease (PD) who take dopamine agonists (DA) develop 5-year pulse control disorders (PIDs). This is demonstrated by a new research published online on "Neurology". The authors of the study, in particular, found that, in patients with Parkinson's disease, the prevalence of ICDs increased from 19.7% initially to 32.8% at age 5, with a cumulative incidence of about 46%.
Based on data from the study "Drug Interactions with Parkinson's Disease Genes" (DIGPD), the results also showed that, after discontinuation of AD, ICDs resolved gradually in about half of the cases. [19659003] A Difficult Balance Between Beneficial Effects and Side Effects
The researchers described the first cases of badociation between AD and ICD in the early 2000s. However, since then, no one has their incidence longitudinally, recalls the authors, led by Jean-Christophe Corvol of Assistance Publique Hospitals of Paris and Departments of Neurology and Genetics of the University Hospital Pitié-Salpêtrière to Paris, France).
ICDs have been followed since the beginning of the DIGPD cohort in 2009, explain Corvol and his colleagues. "The result we got was impressive: about half of the patients under DA developed an ICD during follow-up."
"Since we also had data on DA doses at each visit, we looked at the relationship between ICDs and doses and found a strong relationship between the cumulative dose of AD and ICD." Like all drugs, ADs have side effects, including the risk of IBD, the authors write, but they also offer benefits, such as delayed motor fluctuations and dyskinesia
"We do not believe our results compromise risk. / benefit of these drugs in Parkinson's disease, but balance should be badessed individually for each patient, "explain the authors. "Because ICDs can improve after weaning, our recommendation is to monitor these disorders systematically and cautiously while monitoring patients with Parkinson's disease."
Current findings are in agreement with other studies that detected 47% of 47% cumulative incidence in 46 patients with Parkinson's disease treated with AD (Mov Disord, 2013; 28: 327-333). In addition, research shows that INNs remain common in people with Parkinson's Disease (Parkinsonism, Disat Disord, 2014; 20: 22-26) and may include compulsive badual behavior, hobbies, and hobbies. hypercréativité. AD is the main risk factor (J Clin Neurosci, 2007; 14: 1178-1181).
Study Protocol Based on Longitudinal Data
Researchers recruited consecutive participants for the study. DIGPD longitudinal from May 2009 to July 2013 in four university hospitals and four general hospitals in France. About 41% of the 411 participants were women, the average age of the participants was 62 years and the mean follow-up was 3.3 years
Basic and regular visits, movement disorders specialists semi-structured interviews face to face. They evaluated the symptoms of dopaminergic dysregulation in diet, shopping, cutting, gambling, bad and creativity. They used Part 1 of the Unified Parkinson Disease Scale (MDS-UPDRS) of the Movement Disorder Society which includes a specific article to evaluate dopaminergic dysregulation
Since ICDs can resolve and reappear over time The researchers used generalized equation estimation models to study the badociation between AD and the prevalence of INNs at each visit. During one or more visits, more than 4 out of 10 participants (42.6%) presented an ICD.
73.5% of patients who took a MA in the previous 12 months tended to be younger and male and had a longer duration of illness. There were no other differences between the groups after the researchers made corrections for age, bad and duration of the disease
DCI frequency among DA users compared to those who never took them
ICDs were 2.23 times more common among those who used an AD in the previous 12 months than in those who did not and 4 , 23 times more common among "user-users" versus "users-never" of DA. 19659005] The study population consisted of 306 persons without INN at baseline and at least one additional visit. In total, 94 participants from this group developed ICDs. The five-year cumulative incidence of 46% included an incidence of 51.5% among non-users and 12.4% among non-users
In a correct model, there is no had no difference badociation of standard formulations or prolonged release of DA with ICDs. The researchers also followed 30 patients with an ICD after they stopped taking AD. ICD is progressively resolved, leaving 50% of patients without these disorders 1 year later
The increased prevalence of ICD over time was more pronounced in incident patients than in those whose disease was more long. "ICDs therefore tend to appear in the early years of the disease, while their frequency is more stable after a few years," the researchers write.
Men developed ICD more frequently than women over time (prevalence: 1.13, 95% confidence interval [CI]: 1.02 – 1.26). In addition, younger patients had a higher prevalence of disorders at all visits (1 year prevalence report: 0.97, 95% CI: 0.96 – 0.98).
However, researchers have not found a close connection between levodopa and ICD, "although there is evidence that a higher dose of Levodopa was badociated with a slight increase in the risk of ICDs. The study may have had insufficient power to detect a small effect size or the doses used were too low. "The longest follow-up will allow us to examine this problem," note the researchers.
"When prescribing dopaminergic drugs, the physician must make the patient, the caregiver or the family aware of the risk of IBD and it is very important to inform the patient that he is living with the patient because the patient does not recognize the patient. not systematically behavior, "they add.Idealty is recommended for all patients at the start of treatment and at each subsequent visit.
In addition, patients should be informed that ICD could Once they have stopped the drug. "In doing so, we believe that it is still possible to use these drugs safely in most patients," argue the authors.
The annual longitudinal badessment of a relatively large group of patients with Parkinson's disease is a strong point of the study.This project allowed researchers to evaluate a complete history of the use ADI, the appearance of INNs as a function of time, and any dose-response relationship.
However, the relatively young age of participants is a potential limitation. Younger age is badociated with INNs and the use of AD, which may have contributed to overestimate their frequency. Next steps in research may include examining how to help clinicians identify patients with high-risk INNs
"Currently, our research focuses on genetic risk factors in this population, "say the authors. "In a previous article, we showed that adding genetic information on 13 candidate genes greatly improves the accuracy of a predictive model." Corvol is currently coordinating a project to identify new genes badociated with ICDs in PD
G.O.
Bibliographical reference:
JC Corvol, Artaud F, Cormier-Dequaire F, et al. Longitudinal badysis of impulse control disorders in Parkinson's disease. Neurology, 2018 June 20. doi: 10.1212 / WNL.0000000000005816. [Epub ahead of print] read
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