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Gambling and Parkinson Disease

Gambling and Parkinson Disease The article by Dodd et al1 described 11 patients with Parkinson disease who developed pathological gambling. The authors concluded that because pramipexole was the agonist involved in 9 of the 11 cases, and in 10 of 17 cases reported in the literature, pramipexole may result in gambling to a higher degree as compared with the other agonists, due to its disproportionate stimulation of dopamine D3 receptors. However, although the majority of patients with pathological gambling were taking pramipexole in this study, the total number of patients who were treated with the various agonists was not reported. If many more patients were treated with pramipexole as compared with the other 2 agonists (which is the case in many centers in North America), then it may appear that pramipexole is more responsible than the other agonists unless the denominator (total number of treated patients) is included in the assessment. Similarly, the small number of cases reported in the literature should not be used to reach this conclusion. At the Movement Disorders Clinic in Calgary, Alberta, we have been performing very similar assessments with face-to-face interviews in all patients with idiopathic Parkinson disease seen in clinic over the past 3 months. Results on almost 200 patients have shown that a number developed pathological gambling while being treated with dopamine agonists: 7 on pramipexole, 4 on pergolide, and 3 on ropinirole. However, we also collected data on the total number of patients being treated with each agonist: more than twice as many were on pramipexole as on the other 2 agonists combined. Thus, the risk of developing pathological gambling from our assessment is similar for ropinirole, pergolide, and pramipexole. In our review, we also found that 5 of 39 patients, following surgery for deep brain stimulation of the subthalamic nucleus, developed pathological gambling (in spite of significant reduction or discontinuation of dopamine agonists). Based on our results, use of all 3 dopamine agonists and surgical intervention carry a similar risk. This stresses the importance of doing a systematic prospective review of all patients with Parkinson disease to determine the true incidence of pathologic gambling in this population, as well as the risk associated with different therapeutic interventions. Counseling of all patients is warranted, whether they are starting a variety of medical or surgical therapies. Back to top Article Information Correspondence: Dr Suchowersky, Department of Clinical Neurosciences and Medical Genetics, University of Calgary, Area 3, 3350 Hospital Dr NW, Calgary, Alberta T2N 4N1 (osuchowe@ucalgary.ca). References 1. Dodd MLKlos KJBower JHGeda YEJosephs KAAhlskog JE Pathological gambling caused by drugs used to treat Parkinson disease. Arch Neurol 2005;621377- 1381PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.63.2.298-a
Publisher site
See Article on Publisher Site

Abstract

The article by Dodd et al1 described 11 patients with Parkinson disease who developed pathological gambling. The authors concluded that because pramipexole was the agonist involved in 9 of the 11 cases, and in 10 of 17 cases reported in the literature, pramipexole may result in gambling to a higher degree as compared with the other agonists, due to its disproportionate stimulation of dopamine D3 receptors. However, although the majority of patients with pathological gambling were taking pramipexole in this study, the total number of patients who were treated with the various agonists was not reported. If many more patients were treated with pramipexole as compared with the other 2 agonists (which is the case in many centers in North America), then it may appear that pramipexole is more responsible than the other agonists unless the denominator (total number of treated patients) is included in the assessment. Similarly, the small number of cases reported in the literature should not be used to reach this conclusion. At the Movement Disorders Clinic in Calgary, Alberta, we have been performing very similar assessments with face-to-face interviews in all patients with idiopathic Parkinson disease seen in clinic over the past 3 months. Results on almost 200 patients have shown that a number developed pathological gambling while being treated with dopamine agonists: 7 on pramipexole, 4 on pergolide, and 3 on ropinirole. However, we also collected data on the total number of patients being treated with each agonist: more than twice as many were on pramipexole as on the other 2 agonists combined. Thus, the risk of developing pathological gambling from our assessment is similar for ropinirole, pergolide, and pramipexole. In our review, we also found that 5 of 39 patients, following surgery for deep brain stimulation of the subthalamic nucleus, developed pathological gambling (in spite of significant reduction or discontinuation of dopamine agonists). Based on our results, use of all 3 dopamine agonists and surgical intervention carry a similar risk. This stresses the importance of doing a systematic prospective review of all patients with Parkinson disease to determine the true incidence of pathologic gambling in this population, as well as the risk associated with different therapeutic interventions. Counseling of all patients is warranted, whether they are starting a variety of medical or surgical therapies. Back to top Article Information Correspondence: Dr Suchowersky, Department of Clinical Neurosciences and Medical Genetics, University of Calgary, Area 3, 3350 Hospital Dr NW, Calgary, Alberta T2N 4N1 (osuchowe@ucalgary.ca). References 1. Dodd MLKlos KJBower JHGeda YEJosephs KAAhlskog JE Pathological gambling caused by drugs used to treat Parkinson disease. Arch Neurol 2005;621377- 1381PubMedGoogle ScholarCrossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Feb 1, 2006

Keywords: parkinson disease,gambling

References