Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan.
Department of Neuropathology, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan.
Brain Behav. 2018 Aug;8(8):e01036. doi: 10.1002/brb3.1036. Epub 2018 Jun 29.
Impulse control behaviors (ICBs) are impulsive-compulsive behaviors often associated with dopamine replacement therapy in Parkinson's disease (PD). Although remission can occur in ICB, only four reports on the ratio of remission and the persistence of ICB have been published, and the associated factors with ICB remission or persistence have been little known. Therefore, we conducted a longitudinal assessment of the remission, persistence, and development of ICB and those associated factors in patients with PD.
We retrospectively investigated a PD database at Aomori Prefectural Central Hospital, Japan. One hundred and forty-eight patients with PD who could be followed up for 2 years were enrolled. ICB was assessed using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease. Motor severity (Hoehn and Yahr scale and United Parkinson's Disease Rating Scale), cognitive function (Mini-Mental State Examination), and other clinical variables (sex, age, onset age, disease duration, olfactory dysfunction, and dyskinesia) and medications used to treat PD were assessed. Univariate analyses were performed.
Seven patients were excluded because of the exclusion criteria, and 141 patients were analyzed. Thirty patients (21.3%) had ICB at baseline, and these patients also had significantly higher use of pergolide. The ICB remission rate was 60%, the ICB persistence ratio was 40%, and the ICB development ratio was 12.6% over 2 years. Statistically, younger age and pergolide use were associated with ICB persistence. Being male, having dyskinesia, and rotigotine, entacapone, zonisamide, and istradefylline use were associated with ICB development.
This study suggests that younger age and pergolide use may be the new associated factors with ICB persistence and that entacapone, zonisamide, and istradefylline use may be associated with the development of ICB. Drug profiles and medication practices in Japan may explain the association of these factors with ICB.
冲动控制行为（ICB）是一种冲动-强迫行为，常与帕金森病（PD）中的多巴胺替代疗法相关。尽管 ICB 可能会缓解，但仅有四项关于 ICB 缓解率和持续率的报告，且与 ICB 缓解或持续相关的因素知之甚少。因此，我们对 PD 患者的 ICB 缓解、持续和发展以及相关因素进行了纵向评估。
我们回顾性调查了日本青森县中央医院的 PD 数据库。纳入了 148 名可随访 2 年的 PD 患者。使用帕金森病冲动-强迫障碍问卷评估 ICB。运动严重程度（Hoehn 和 Yahr 量表和统一帕金森病评定量表）、认知功能（简易精神状态检查）和其他临床变量（性别、年龄、发病年龄、病程、嗅觉功能障碍和运动障碍）以及用于治疗 PD 的药物也进行了评估。进行了单变量分析。
有 7 名患者因排除标准被排除，共分析了 141 名患者。30 名患者（21.3%）在基线时有 ICB，这些患者也更频繁地使用培高利特。2 年内 ICB 的缓解率为 60%，持续率为 40%，发展率为 12.6%。统计学上，年龄较小和使用培高利特与 ICB 持续相关。男性、有运动障碍、使用罗替高汀、恩他卡朋、左乙拉西坦和依曲茶碱与 ICB 发展相关。
本研究表明，年龄较小和使用培高利特可能是 ICB 持续的新相关因素，而恩他卡朋、左乙拉西坦和依曲茶碱的使用可能与 ICB 的发展相关。日本的药物概况和用药实践可能解释了这些因素与 ICB 的关联。
