Affiliations: Department of Neuropsychiatry, The Michael Trimble
Neuropsychiatry Research Group, BSMHFT and University of Birmingham,
Birmingham, UK | Department of Motor Neuroscience and Movement
Disorders, Institute of Neurology and University College London, London,
UK
Note: [] Corresponding author: Dr. Andrea Eugenio Cavanna MD, Department
of Neuropsychiatry, The Barberry National Centre for Mental Health, Birmingham
B15 2FG, UK. Tel.: +44 121 3012317; Fax: +44 121 3012291; E-mail:
a.cavanna@ion.ucl.ac.uk
Abstract: Aims: This review aims to evaluate the most recent evidence on the
pathophysiology of impulse control disorders (ICDs) in Parkinson disease
(PD). Methods: Computerised searches of Medline, Embase and PsycInfo,
along with manual searches for grey literature, were conducted and resulted in
a total of 16 studies suitable for review. Results: Evidence was divided into four categories: medication used
in PD management, imaging studies, genetic analysis and subthalamic deep brain
stimulation (STN-DBS). Analysis of the literature reveals that both intrinsic
and extrinsic factors may play a role in the pathophysiology of ICDs in PD.
Dysfunction of the mesocorticolimbic pathway and polymorphisms of the dopamine
D3 and D4 receptors may increase an individual's susceptibility to the
development of ICDs. Discussion: Dopaminergic medication, particularly dopamine agonists
(DAs), increases the risk of developing impulsive behaviours in a PD patient.
Further evidence, particularly in the form of prospective studies and
randomised controlled trials is required to better establish the
pathophysiology of ICDs in PD.
Keywords: Deep brain stimulation, dopamine agonists, impulse control disorders, levodopa, Parkinson's disease, pathological gambling
