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EDITORIALS: Sui H Wong and Malcolm J Steiger Pathological gambling in Parkinson's disease BMJ 2007; 334: 810-811 [Full text]

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Pharmacovigilance and Parkinson’s disease

Kaushik Sanyal Clinical Fellow K Sabanathan Consultant Physician   (22 April 2007)

Pharmacovigilance and Parkinson’s disease 22 April 2007
Kaushik Sanyal Clinical Fellow K Sabanathan Consultant Physician, Movement Disorder Clinic Norfolk and Norwich University Hospital Send response to journal: Re: Pharmacovigilance and Parkinson’s disease	We know that dopamine agonists are a good alternative to levadopa, with less risk of motor complications and short duration of action but that they give short time side effects like manic state, hallucinations, somnolence, or hypersexual behaviour . Pathological gambling, a psychiatric disorder or dopamine dysregulation syndrome (DDS), is an interesting comorbid condition to look at. DDS is due to pulsatile overstimulation of the limbic dopaminergic system. Positive personal or family history of alcohol use disorder can be a risk factor. Certain drugs like quetiapine, valproic acid and serotonergic antidepressants can initiate these features. Careful choices of antidepressants, neuroleptics, sedatives are a pharmacologic treatment option. Evidence has showed that by stimulation of bilateral sub thalamic nucleus deep brain stimulation of D3 receptor may be helpful. It is prudent to make the patient and the family aware of the dopamine agonist adverse effects. Competing interests: None declared