Service de neurologie et pathologie du mouvement, hôpital de la Timone, Marseille cedex, France.
Rev Neurol (Paris). 2012 Aug-Sep;168(8-9):624-33. doi: 10.1016/j.neurol.2012.06.014. Epub 2012 Aug 24.
In Parkinson's disease, the degeneration of the dopaminergic system and the longstanding exposure to dopamine replacement therapy (DRT) may cause, in a group of vulnerable patients, dysregulation of the brain reward system.
These patients develop DRT-related compulsions, which include addiction to levodopa or dopamine dysregulation syndrome (DDS), punding, and impulse control disorders (ICDs). ICDs or behavioral addiction reported in Parkinson's disease include pathological gambling, hypersexuality, compulsive buying and binge eating. Although the underlying pathophysiology is still poorly understood, these behaviors are linked by their reward-based and repetitive nature. Such behaviors may result in devastating psychosocial impairment for the patients and are often hidden.
The recognition of these behaviors is important and allows a better clinical management. Although the limited data do not permit particular therapeutic strategies, some approaches are worth considering: DRT reduction, trials of non-dopaminergic medications and subthalamic chronic stimulation.
在帕金森病中，多巴胺能系统的退化和长期暴露于多巴胺替代疗法（DRT）可能导致一群易受影响的患者的大脑奖励系统失调。
这些患者出现与 DRT 相关的强迫症状，包括对左旋多巴或多巴胺失调综合征（DDS）的成瘾、冲动控制障碍（ICD）、刻板行为和冲动控制障碍（ICD）。帕金森病中报道的 ICD 或行为成瘾包括病理性赌博、性欲亢进、强迫性购物和暴食。尽管其潜在的病理生理学仍不清楚，但这些行为的共同点是基于奖励和重复的性质。这些行为可能导致患者遭受严重的社会心理损害，而且往往是隐藏的。
认识到这些行为很重要，可以更好地进行临床管理。尽管有限的数据不允许采用特定的治疗策略，但一些方法值得考虑：减少 DRT、尝试非多巴胺能药物和丘脑底核慢性刺激。
