Service de neurologie, université de Franche-Comté, CHRU de Besançon, 25030 Besançon, France; Unité extrapyramidale, département des neurosciences cliniques, HUG, faculté de médecine, université de Genève, 1205 Genève, Suisse.
Unité extrapyramidale, département des neurosciences cliniques, HUG, faculté de médecine, université de Genève, 1205 Genève, Suisse.
Rev Neurol (Paris). 2018 Nov;174(9):653-663. doi: 10.1016/j.neurol.2018.07.005. Epub 2018 Sep 14.
Impulse control disorders (ICDs) and other related behaviors, such as punding and dopamine dysregulation syndrome, are frequent yet underrecognized non-motor complications of dopamine replacement therapy (DRT) in Parkinson's disease (PD); they can also have a major negative impact on quality of life. They result from complex interactions between a given individual's predispositions, non-physiological dopaminergic stimulation and PD pathology. Also, sensitization of the mesocorticolimbic pathway, reflected by the psychotropic effects of dopaminergic treatment, plays a crucial role in the emergence of these addictive behaviors. While early detection of changes in behavior, less use of dopamine agonists (DA) that have a relative selectivity for mesocorticolimbic dopamine receptors, and fractionation of levodopa dosages to avoid non-physiological pulsatile stimulation of dopamine receptors are key strategies in the management of this hyperdopaminergic behavioral spectrum, other complementary approaches are also addressed in this review.
冲动控制障碍（ICD）和其他相关行为，如刻板行为和多巴胺失调综合征，是帕金森病（PD）中多巴胺替代疗法（DRT）的常见但未被充分认识的非运动并发症；它们也会对生活质量产生重大负面影响。它们是由特定个体的易感性、非生理多巴胺能刺激和 PD 病理学之间的复杂相互作用引起的。此外，中脑边缘多巴胺通路的敏化，反映在多巴胺能治疗的精神作用中，在这些成瘾行为的出现中起着至关重要的作用。虽然早期发现行为变化、减少使用对中脑边缘多巴胺受体具有相对选择性的多巴胺激动剂（DA）以及将左旋多巴剂量分馏以避免非生理脉冲式多巴胺受体刺激是管理这种高多巴胺能行为谱的关键策略，但本文还探讨了其他补充方法。
