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The publication twenty years ago describing excessive therapeutic drug dosing in some Parkinson's disease patients foreshadowed behaviours now well recognised.
The recognition and description of a behavioural syndrome in a group of patients with Parkinson’s disease (PD) who take dopamine replacement therapy in quantities beyond what is required to treat motor symptoms 20 years ago1 sparked interest for a number of reasons. In addition to its deficiency being integral to PD, dopamine had long been regarded as a critical neurotransmitter involved in reward systems reduction in dopamine associated with depression and increased dopamine with addiction. Within the addiction field, these patients represented a real-life experiment to support the prevailing models suggesting maladaptive mesolimbic dopamine circuits underlying addiction.2 Conversely in the field of neurology, the paper highlighted and built on occasional observations and case reports of abnormal behaviour with excessive use of dopaminergic medication in PD, and proposed a pathophysiological framework within which these behaviours could be understood.
Too much of a good thing: hedonistic homoeostatic dysregulation and other behavioural consequences of excessive dopamine replacement therapy in Parkinson's disease
Authors: John Daniel O’Sullivan
Year Published: 2000
Number of times cited: 635
The appellation ‘hedonistic homoeostatic dysregulation’ was idiosyncratic and served two main purposes in addition to its novelty to neurologists.1 First it emphasised the similarity between this behaviour in PD and generic drug abuse or dependence with the term initially used to describe to describe a neurobiological theory of drug addiction.3 Second it circumvented the use of the pejorative term ‘addiction’, particularly when the drugs that are being misused in these patients are necessary …