RT Journal Article
SR Electronic
T1 Clinical features of dopamine agonist withdrawal syndrome in a movement disorders clinic
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 130
OP 135
DO 10.1136/jnnp-2012-302684
VO 84
IS 2
A1 Margarita Pondal
A1 Connie Marras
A1 Janis Miyasaki
A1 Elena Moro
A1 Melissa J Armstrong
A1 Antonio P Strafella
A1 Binit B Shah
A1 Susan Fox
A1 L K Prashanth
A1 Nicolas Phielipp
A1 Anthony E Lang
YR 2013
UL http://jnnp.bmj.com/content/84/2/130.abstract
AB 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 Out of 487 PD patient charts reviewed, 84 were withdrawn from the agonists and were evaluable.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.