Infusion Therapies and Development of Impulse Control Disorders in Advanced Parkinson Disease: Clinical Experience After 3 Years' Follow-up

Background: In Parkinson disease (PD), compulsive behaviors, cumulatively termed impulse control disorders (ICDs), are known to develop in patients receiving dopamine-replacement therapy with oral dopamine agonists being particularly implicated. However, the effects of continuous infusion therapies have not been explored. Objectives: We report data from a 3-year clinical observational screening of our active cohort of patients receiving apomorphine (Apo) infusion and intrajejunal levodopa infusion (IJLI) for development or attenuation of ICDs. Methods: Forty-one patients (24 male/17 female, mean age 61.9 +/- 10.9 years; PD duration 14.2 +/- 4.5 years) on Apo (mean dose 106 +/- 24 mg; mean duration of infusion 16 h/d) and 19 patients (13 male/6 female, mean age 58.6 +/- 8.2 years; PD duration 16.2 +/- 5.7 years) on IJLI (mean dose 1990 +/- 807 mg; mean duration of infusion 16 h/d) were screened and observed prospectively for development of nonmotor symptoms and ICD at 3 monthly follow-ups for up to 3 years. Results: In Apo group, 4 patients had preexisting ICD, and in 1 patient, ICD (binge eating) completely resolved after being started on Apo. In 3 others, ICDs continue but attenuated after Apo. However, 7 new cases of ICDs developed in the Apo group, but in only 1 (2.4%), Apo had to be discontinued. Furthermore, in 3 with binge eating, the ICDs resolved after 2 months with Apo infusion being continued. In the IJLI group, 8 patients with active ICDs showed attenuation of the behavior after IJLI initiation. At 3 years, 2 of these patients continue to have ICD. No new ICDs have developed. Conclusions: Strategies utilizing continuous drug delivery appear to have a relatively low risk of development of ICD. Apomorphine and IJLI can be used in cases with ICD if clinically indicated, with IJLI therapy possibly emerging as the most advantageous in this setting.