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Institute of
Neurology, Queen Square, London WC1N 3BG, UK
Correspondence to: Dr G Giovannoni, Departments of Neurochemistry and Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG, UK email G.Giovannoni{at}ion.ucl.ac.uk
Received 7 April 1999 and in revised form 20 August 1999;
Accepted 24 August
1999
Hedonistic homeostatic dysregulation is a
neuropsychological behavioural disorder associated with substance
misuse and addiction. The disorder has been recognised as a consequence
of dopamine replacement therapy (DRT) in 15 patients with Parkinson's
disease. The syndrome typically develops in male patients with early
onset Parkinson's disease, and can occur with orally and
subcutaneously administered DRT. These patients take increasing
quantities of their DRT, despite increasingly severe drug induced
dyskinesias, and may develop a cyclical mood disorder with hypomania or
manic psychosis. There is impairment of social and occupational
functioning. Tolerance develops to mood elevating effects of DRT and a
negative affective withdrawal state occurs if the drugs are withdrawn
or doses decreased. The clinical features and guidelines for managing this syndrome are discussed. A set of diagnostic criteria for further
investigating this condition is proposed.
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