How are impulse behaviors treated in patients with Parkinson disease (PD)?

Updated: Jan 24, 2019
  • Author: Robert A Hauser, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Cognitive-behavioral therapy (CBT) can help control impulse behaviors in PD. In a study of 45 patients with idiopathic PD and associated impulse control behaviors that had not responded to standard treatment, CBT significantly improved symptom severity, neuropsychiatric disturbances, and depression and anxiety levels. Of the 45 patients, 17 were randomly assigned to a 6-month wait list for CBT along with standard medical care and 28 were randomized to CBT starting immediately. Among the 28 patients in the treatment group, 58% completed all 12 sessions of CBT and 88% completed at least 6. Three-quarters of those receiving the treatment had improved symptom severity compared with only about a third of those who did not receive the therapy. [113, 114]

In a placebo-controlled pilot study of 50 patients with idiopathic PD who developed impulse control disorder (ICD) symptoms while receiving dopamine agonist treatment, Papay and colleagues found that the opioid antagonist naltrexone improved ICD symptoms, as measured on a PD-specific rating scale. [115, 116]

Naltrexone was administered at 50 mg daily for 4 weeks and then increased to 100 mg daily for 4 weeks in nonresponders. The difference in response rate on the Clinical Global Impression-Change (CGI-C) scale between the naltrexone (54.5%) and placebo (34.8%) groups was not significant (P = 0.23). Estimated changes on the patient-completed Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) from baseline to week 8, however, significantly favored naltrexone: a change of 14.9 points for naltrexone vs 7.5 points for placebo (P = 0.04). Nausea and headache were the most common side effects of naltrexone treatment. [115, 116]


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