From the Assistance Publique Hôpitaux de Paris (J.-C.C., F.C.-D., L.L., C.B., D.G., S.K., G.M., H.Y., A.B., M.V.); Sorbonne Université (J.-C.C., F.C.-D., L.L., C.B., D.G., S.K., G.M., H.Y., A.B., M.V.); INSERM (J.-C.C., F.C.-D., L.L., C.B., D.G., S.K., G.M., H.Y., A.B., M.V.), Institut du cerveau et de la Moelle, Centre d'Investigation Clinique Neurosciences, NS-PARK/FCRIN Network; CNRS (J.-C.C., F.C.-D., L.L., C.B., D.G., S.K., G.M., H.Y., A.B., M.V.); Departments of Neurology and Genetics (J.-C.C., F.C.-D., L.L., C.B., D.G., S.K., G.M., H.Y., A.B., M.V.), Hôpital Pitié-Salpêtrière, Paris; CESP (F.A., A.E.), Faculte de médecine, Université Paris-Sud; Faculte de médecine (F.A., A.E.), UVSQ, Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Villejuif; University of Toulouse 3 (O.R., C.B.-C., F.O.-M), Centre Hospitalo-Universitaire de Toulouse and INSERM; Centre d'Investigation Clinique CIC1436 (O.R., C.B.-C., F.O.-M), NS-PARK/FCRIN Network, Départements de Neurosciences et de Pharmacologie Clinique, NeuroToul COEN Center, Toulouse; Department of Neurology (F.D., A.-R.M.), NS-PARK/FCRIN Network, Centre Hospitalo-Universitaire de Clermont-Ferrand; Department of Neurology (P.D.), NS-PARK/FCRIN Network, Centre Hospitalo-Universitaire de Nantes; Department of Neurology (F.B.), Hôpital Foch, Suresnes; Department of Neurology (J.-P.B.), Fondation Rothschild, Paris; Department of Neurology (F.P.), Centre Hospitalier de Versailles; Université Versailles Saint Quentin en Yvelines et Paris Saclay (F.P.), Versailles; Department of Neurology (V.M.), Centre Hospitalo-Universitaire Saint-Antoine, Paris, France; and Department of Health Care Management (P.-C.L.), College of Health Technology, National Taipei University of Nursing and Health Sciences, Taiwan.
Neurology. 2018 Jul 17;91(3):e189-e201. doi: 10.1212/WNL.0000000000005816. Epub 2018 Jun 20.
To investigate the longitudinal dose-effect relationship between dopamine replacement therapy and impulse control disorders (ICDs) in Parkinson disease (PD).
We used data from a multicenter longitudinal cohort of consecutive patients with PD with ≤5 years' disease duration at baseline followed up annually up to 5 years. ICDs were evaluated during face-to-face semistructured interviews with movement disorder specialists. Generalized estimating equations and Poisson models with robust variance were used to study the association between several time-dependent definitions of dopamine agonist (DA) use, taking dose and duration of treatment into account, and ICDs at each visit. Other antiparkinsonian drugs were also examined.
Among 411 patients (40.6% women, mean age 62.3 years, average follow-up 3.3 years, SD 1.7 years), 356 (86.6%) took a DA at least once since disease onset. In 306 patients without ICDs at baseline, the 5-year cumulative incidence of ICDs was 46.1% (95% confidence interval [CI] 37.4-55.7, DA ever users 51.5% [95% CI 41.8-62.1], DA never users 12.4% [95% CI 4.8-30.0]). ICD prevalence increased from 19.7% at baseline to 32.8% after 5 years. ICDs were associated with ever DA use (prevalence ratio 4.23, 95% CI 1.78-10.09). Lifetime average daily dose and duration of treatment were independently associated with ICDs with significant dose-effect relationships. Similar analyses for levodopa were not in favor of a strong association. ICDs progressively resolved after DA discontinuation.
In this longitudinal study of patients with PD characterized by a high prevalence of DA treatment, the 5-year cumulative incidence of ICDs was ≈46%. ICDs were strongly associated with DA use with a dose-effect relationship; both increasing duration and dose were associated with ICDs. ICDs progressively resolved after DA discontinuation.
NCT01564992.
探讨帕金森病（PD）中多巴胺替代疗法与冲动控制障碍（ICD）之间的纵向剂量-效应关系。
我们使用了一项多中心纵向队列研究的数据，该研究纳入了基线时病程≤5 年的连续 PD 患者，并在 5 年内每年进行随访。ICD 通过运动障碍专家的面对面半结构化访谈进行评估。采用广义估计方程和泊松模型（考虑治疗剂量和时间），研究了几种时间依赖性的多巴胺激动剂（DA）使用定义与每次就诊时 ICD 之间的关联。还检查了其他抗帕金森病药物。
在 411 名患者（40.6%为女性，平均年龄 62.3 岁，平均随访时间 3.3 年，SD 1.7 年）中，有 356 名（86.6%）自疾病发作以来至少使用过一次 DA。在基线时无 ICD 的 306 名患者中，ICD 的 5 年累积发生率为 46.1%（95%CI 37.4-55.7，曾使用 DA 者为 51.5%[95%CI 41.8-62.1]，从未使用 DA 者为 12.4%[95%CI 4.8-30.0]）。ICD 的患病率从基线时的 19.7%增加到 5 年后的 32.8%。ICD 与曾使用 DA 相关（患病率比 4.23，95%CI 1.78-10.09）。终生平均日剂量和治疗持续时间与 ICD 独立相关，存在显著的剂量-效应关系。对左旋多巴的类似分析并不支持两者之间存在很强的关联。DA 停药后 ICD 逐渐缓解。
在这项对 PD 患者进行的纵向研究中，患者以高比例的 DA 治疗为特征，ICD 的 5 年累积发生率约为 46%。ICD 与 DA 使用密切相关，且存在剂量效应关系；剂量和时间的增加都与 ICD 相关。DA 停药后 ICD 逐渐缓解。
NCT01564992。
