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Dopamine agonist withdrawal syndrome (DAWS) in a patient with a microprolactinoma
  1. Benedetta Demartini1,2,
  2. Lucia Ricciardi1,3,
  3. Alexandra Ward4,
  4. Mark J Edwards1
  1. 1Sobell Department, UCL Institute of Neurology, London, UK
  2. 2Department of Psychiatry, San Paolo Hospital and University of Milan, Milan, Italy
  3. 3Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
  4. 4Department of Diabetes and Endocrinology, Royal United Hospital, Bath, UK
  1. Correspondence to Dr Mark Edwards, Sobell Department, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; m.j.edwards{at}ucl.ac.uk

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Dopamine agonist withdrawal syndrome (DAWS) is a recently described syndrome where patients withdrawn from long-term treatment with dopamine agonists experience a constellation of neuropsychiatric and autonomic symptoms. It was first described by Rabinak and Nirembergé1 in a cohort of patients with Parkinson's disease (PD), where most were withdrawing DA because of the development of impulse control disorders (ICD). Others have since published larger case series of PD patients2 ,3 confirming the common symptoms (depression, anxiety, fatigued, dysphoria, irritability, agitation, pain, sleep disturbances, diaphoresis and orthostatic hypotension) and that the overwhelming majority of patients who develop DAWS on withdrawal of DA experienced ICD while on DA. In retrospect, the non-motor syndrome reported to occur on sudden cessation of DA following deep brain stimulation surgery for PD4 could be a description of DAWS. The pathophysiology of this syndrome is still unclear but a sudden change in dopaminergic stimulation might be the causative mechanism5 as it is hypothesised for other acute emergency syndromes such as acute dystonic reactions and neuroleptic malignant syndrome, where similar psychiatric and autonomic …

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