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Research paper
Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic
  1. Margarita Pondal,
  2. Connie Marras,
  3. Janis Miyasaki,
  4. Elena Moro,
  5. Melissa J Armstrong,
  6. Antonio P Strafella,
  7. Binit B Shah,
  8. Susan Fox,
  9. L K Prashanth,
  10. Nicolas Phielipp,
  11. Anthony E Lang
  1. The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Margarita Pondal, Movement Disorders Centre, Toronto Western Hospital, University of Toronto, and the Edmond J. Safra Program in Parkinson's Disease, McLaughlin Pavilion, 7th Floor, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada; mpondals{at}


Background Recently, symptoms similar to addictive drug withdrawal have been reported in a structured longitudinal study of patients with idiopathic Parkinson's Disease (PD) withdrawing from dopamine agonists (DA): the dopamine agonist withdrawal syndrome (DAWS).

Objectives The objective of this study was to establish the frequency, predictors, and outcomes of DAWS in a movement disorders clinic.

Methods We conducted a retrospective chart review of a sample of patients with a clinical diagnosis of PD treated with DA in whom withdrawal or attempted withdrawal of DA was carried out because of adverse effects, or for any other reason. Out of 487 PD patient charts reviewed, 84 were withdrawn from the agonists and were evaluable.

Results Thirteen patients (15.5%) met criteria for DAWS (DAWS+) and 71 did not (DAWS−). DAWS developed upon withdrawal from pergolide, pramipexole and ropinirole, and did not respond to levodopa. DAWS outcomes included recovery in less than 6 months in 61%, in more than a year in 23%, and an inability to discontinue DA in 15% of patients. Development of impulse control disorders was the reason for DA withdrawal in all DAWS+, but only in 41% of DAWS− patients (p<0.0001). DAWS+ and DAWS− patients did not differ in other variables.

Conclusion DAWS is a disabling complication of DA use. Critical features of the syndrome are the strong link with impulse control disorders, possibly the independence of DA dosage and type, and the resistance to treatment, including levodopa. Further studies are required to characterise those at risk as well as to define an effective treatment.

  • Behavioural manifestations in Parkinson's disease
  • dopamine agonists
  • impulse control disorders
  • Parkinson's disease treatment
  • withdrawal syndrome

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  • Competing interests MP: received funds from University of Toronto for travelling and registering at the AAN meeting, Honolulu 2012, to present data related to the study that is being submitted. CM: consulting compensation from Solvay Pharmaceuticals. JM: Teva Consulting, clinical trial. National Institutes of Health. NET PD studies. Independent clinical monitor. Neurogen 2009 data safety monitor committee chair. EM: received honorarium from Medtronics. AS: governmental organisation grant. SF: scientific advisory board for Merck Serono, Merz. Merck Serono clinical trial, site PI. AL: consultant for research projects, drug development, etc. Abbott, Allon Therapeutics, Astra Zenica, Biovail, Boerhinger-Ingelheim, Cephalon, Ceregene, Eisai, Medtronic, Lundbeck A/S, Novartis, Merk Serono, Solvay, Teva. Expert witness: cases related to the welding industry. Canadian Institutes of Health Research, Dystonia Medical Research Foundation, Michael J. Fox Foundation, National Parkinson's Foundation, Ontario Problem Gambling Research Centre. MA, BS, LKP and NP: nothing to disclose.

  • Ethics approval Provided by the Research Ethics Board of University Health Network, Toronto, Ontario, Canada.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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