Quebec Memory and Motor Skills Disorders Research Center, Clinique Sainte-Anne, Québec, Québec, Canada.
J Neurol Sci. 2010 Mar 15;290(1-2):52-6. doi: 10.1016/j.jns.2009.11.010. Epub 2009 Dec 6.
Since the introduction of levodopa therapy and dopaminergic replacement therapy to abate symptoms of idiopathic Parkinson's disease, repetitive compulsive behaviors have been reported and are now considered to be drug-related response complications. As dopamine (DA) agonists are the licensed treatment in Restless Legs Syndrome (RLS), a survey was conducted to determine the extent to which patients with RLS present compulsive behaviors. The aim of this study was to investigate the relationship between DA agonists and the occurrence of motor or behavioral compulsions, stress, depression, and sleep disturbance in RLS patients. A questionnaire was mailed three times, at four-month intervals over a period of 8 months to all patients of the Quebec Memory and Motor Skills Disorders Clinic diagnosed with RLS. In addition to recording all medication information for RLS treatment, patients were assessed on the International Restless Legs Syndrome Study Group Rating Scale (IRLS), the Beck Depression Inventory-II (BDI-II), the Sleep Scale from the Medical Outcomes Study (MOS) and on a visual analog scale for current level of stress. A section pertaining to hobby, mania, and compulsion was also included. Analyses are based on 97 out of 151 patients (64.2%) with RLS who returned the three questionnaires. Twelve patients (12.4%) on stable DA agonist therapy (average dose 0.52+/-0.59 mg Pramipexole equivalent) developed a new compulsive behavioral repertoire. Eating (3 women, 1 man), buying food or clothes (2 women, 1 man), trichotillomania (1 woman, 1 man), and gambling (1man) were among the compulsions developed under DA treatment. In addition, two women presented new tic-like phenomena. In contrast to the RLS patients without compulsive behaviors (53 treated with DA agonist; 32 untreated), those with compulsive habits reported experiencing more stress, depression and sleep problems. Patients with RLS with mood and stress states may be at greater risk of developing compulsive behaviors while receiving standard dosage DA agonist treatment. These behaviors are clearly linked to short-term satisfaction and underline the role of dopaminergic mesolimbic stimulation in the reinforcement process of rewarding behavioral sequences.
自从左旋多巴治疗和多巴胺替代疗法被引入以缓解特发性帕金森病的症状以来，已经报道了重复性强迫行为，现在这些行为被认为是与药物相关的反应并发症。由于多巴胺（DA）激动剂是不安腿综合征（RLS）的许可治疗方法，因此进行了一项调查，以确定 RLS 患者出现强迫行为的程度。本研究的目的是调查 DA 激动剂与 RLS 患者运动或行为强迫、压力、抑郁和睡眠障碍发生之间的关系。在 8 个月的时间里，每隔 4 个月，通过邮件向魁北克记忆和运动技能障碍诊所诊断为 RLS 的所有患者发送了三次问卷。除了记录所有治疗 RLS 的药物信息外，患者还接受了国际不安腿综合征研究组评分量表（IRLS）、贝克抑郁量表第二版（BDI-II）、医疗结果研究睡眠量表（MOS）和当前压力水平的视觉模拟量表的评估。还包括一个关于业余爱好、躁狂和强迫的部分。分析基于返回三份问卷的 151 名 RLS 患者中的 97 名（64.2%）。12 名（12.4%）接受稳定 DA 激动剂治疗（平均剂量 0.52+/-0.59mg 普拉克索等效物）的患者出现了新的强迫性行为。饮食（3 名女性，1 名男性）、购买食物或衣服（2 名女性，1 名男性）、拔毛癖（1 名女性，1 名男性）和赌博（1 名男性）是在 DA 治疗下出现的强迫行为之一。此外，两名女性出现了新的抽搐样现象。与没有强迫行为的 RLS 患者（53 名接受 DA 激动剂治疗；32 名未接受治疗）相比，有强迫习惯的患者报告说他们经历了更多的压力、抑郁和睡眠问题。患有 RLS 且有情绪和压力状态的患者在接受标准剂量 DA 激动剂治疗时可能更容易出现强迫行为。这些行为显然与短期满足感有关，并强调了中脑多巴胺能边缘刺激在强化奖励行为序列中的作用。
