Sasikumar Sanskriti, Matta Roberto, Munhoz Renato P, Zurowski Mateusz, Poon Yu-Yan, Hodaie Mojgan, Kalia Suneil K, Lozano Andres M, Fasano Alfonso
Division of Neurology University of Toronto Toronto Ontario Canada.
University of Cagliari Cagliari Italy.
Mov Disord Clin Pract. 2021 Mar 11;8(3):400-405. doi: 10.1002/mdc3.13154. eCollection 2021 Apr.
Dopamine Dysregulation Syndrome (DDS) is an adverse non-motor complication of dopamine replacement therapy in Parkinson's disease. The current literature on this syndrome is limited, and it remains underdiagnosed and challenging to manage.
To assess the role of advanced therapies in the management of DDS.
We performed a retrospective chart review and identified patients who fit the inclusion criteria for DDS. They were classified according to risk factors that have been identified in the literature, motor and complication scores, intervention (medical or surgical) and outcome. Multivariate analyses were performed to analyze these characteristics.
Twenty-seven patients were identified (23 males, mean age of onset: 49 ± 8.8 years). Average levodopa equivalent daily dose was 1916.7 ± 804 mg and a history of impulse control disorders, psychiatric illness, and substance abuse was present in 89%, 70% and 3.7% of the patients, respectively. Overall 81.5% of patients had symptom resolution at follow up, on average 4.8 ± 3.5 years after management, with medication only (7/9), levodopa-carbidopa intestinal gel (1/3), deep brain stimulation of subthalamic nucleus (10/13), or globus pallidus pars interna (2/2). Reduction of medications occurred with deep brain stimulation of subthalamic nucleus ( = 0.01) but was associated with a relapse in two patients.
Although the small sample size of some subgroups limits our ability to draw meaningful conclusions, our results did not suggest superiority of a single treatment option. Advanced therapies including deep brain stimulation can be considered in patients with DDS refractory to conservative measures, but outcome is variable and relapse is possible.
多巴胺失调综合征（DDS）是帕金森病多巴胺替代治疗的一种不良非运动并发症。目前关于该综合征的文献有限，其诊断仍不足且管理具有挑战性。
评估先进疗法在DDS管理中的作用。
我们进行了一项回顾性病历审查，确定符合DDS纳入标准的患者。根据文献中确定的危险因素、运动和并发症评分、干预措施（药物或手术）及结果对他们进行分类。进行多变量分析以分析这些特征。
共确定27例患者（23例男性，平均发病年龄：49±8.8岁）。左旋多巴等效每日剂量平均为1916.7±804mg，分别有89%、70%和3.7%的患者有冲动控制障碍、精神疾病和药物滥用史。总体而言，81.5%的患者在随访时症状得到缓解，平均在治疗后4.8±3.5年，仅通过药物治疗（7/9）、左旋多巴 - 卡比多巴肠凝胶（1/3）、丘脑底核深部脑刺激（10/13）或苍白球内侧部（2/2）。丘脑底核深部脑刺激可减少药物使用（P = 0.01），但有2例患者出现复发。
尽管一些亚组的样本量较小限制了我们得出有意义结论的能力，但我们的结果并未表明单一治疗方案具有优越性。对于保守措施难治的DDS患者，可考虑包括深部脑刺激在内的先进疗法，但结果存在差异且可能复发。
