多巴胺激动剂治疗帕金森病患者的冲动控制障碍：一项多中心研究。

Impulse control disorder in patients with Parkinson's disease under dopamine agonist therapy: a multicentre study.

机构信息

Department of Neurology, Fundacion Jimenez Diaz, Madrid, Spain.

Department of Neurology, IRYCIS, Hospital Ramon y Cajal, Madrid, Spain.

出版信息

J Neurol Neurosurg Psychiatry. 2014 Aug;85(8):840-4. doi: 10.1136/jnnp-2013-306787. Epub 2014 Jan 16.

DOI:10.1136/jnnp-2013-306787

PMID:24434037

Abstract

BACKGROUND

Impulse control disorders (ICDs) encompass a wide spectrum of abnormal behaviour frequently found in cases of Parkinson's disease (PD) treated with dopamine agonists (DAs). The main aim of this study was to analyse ICD prevalence with different DAs.

METHODS

We carried out a multicentre transversal study to evaluate the presence of ICDs in patients with PD chronically treated (>6 months) with a single non-ergolinic DA (pramipexole, ropinirole, or rotigotine). Clinical assessment of ICD was performed using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease.

RESULTS

Thirty-nine per cent of patients (91/233) fulfilled the clinical criteria for ICD. The group of patients with ICD symptoms (ICD+) differed from those without ICD symptoms (ICD-) in younger age and type of DA intake. Oral DA treatment (pramipexole and ropinirole) was associated with higher risk of ICDs compared with transdermal DA (rotigotine): 84/197 (42%) patients treated with oral DA developed ICD, versus 7/36 (19%) patients treated with transdermal DA (Fisher's exact text <0.01). In univariate analysis, a younger age (p<0.01), treatment with rasagiline (p<0.05), and especially treatment with an oral DA (pramipexole or ropinirole) (p<0.01) were significantly associated with ICD. Multivariate analysis confirmed that oral DA remained significantly associated with ICD (p: 0.014, OR: 3.14; 1.26-7.83).

CONCLUSIONS

ICD was significantly associated with the use of the non-ergolinic oral DA (pramipexole and ropinirole) when compared with transdermal non-ergolinic DA (rotigotine). Since pramipexole, ropinirole and rotigotine are non-ergolinic DAs with very similar pharmacodynamic profiles, it is likely that other factors including route of administration (transdermal vs oral) explain the difference in risk of ICD development.

摘要

背景

冲动控制障碍（ICD）包括一系列异常行为，这些行为在接受多巴胺激动剂（DAs）治疗的帕金森病（PD）患者中经常出现。本研究的主要目的是分析不同 DAs 治疗时 ICD 的患病率。

方法

我们进行了一项多中心横断面研究，以评估长期（>6 个月）接受单一非麦角类 DA（普拉克索、罗匹尼罗或罗替高汀）治疗的 PD 患者中 ICD 的存在情况。使用帕金森病冲动-强迫障碍问卷对 ICD 进行临床评估。

结果

39%的患者（91/233）符合 ICD 临床标准。有 ICD 症状（ICD+）的患者组与无 ICD 症状（ICD-）的患者组在年龄和 DA 摄入类型上存在差异。与透皮 DA（罗替高汀）相比，口服 DA（普拉克索和罗匹尼罗）治疗与更高的 ICD 风险相关：口服 DA 治疗的 84/197（42%）患者出现 ICD，而透皮 DA 治疗的 7/36（19%）患者出现 ICD（Fisher 确切检验<0.01）。在单变量分析中，年龄较小（p<0.01）、使用雷沙吉兰（p<0.05）、特别是使用口服 DA（普拉克索或罗匹尼罗）（p<0.01）与 ICD 显著相关。多变量分析证实，口服 DA 与 ICD 显著相关（p：0.014，OR：3.14；1.26-7.83）。