Parkinson’s drugs may trigger gambling obsession

• Neurology • Sep 17, 2005



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Recent reports suggest that pathologic gambling, a severe addiction to gambling, is a rare complication of using anti-Parkinson’s drugs. Now, new research delves deeper into this association and reveals that the gambling may resolve when the drug is stopped and that the drug pramipexole is often implicated.

The findings, which appear in the Archives of Neurology, are based on a study of 11 patients with Parkinson’s disease and pathologic gambling who were seen at the Mayo Clinic between 2002 and 2004. Despite having had no previous history of compulsive gambling, one patient had lost more than $200,000 and another in excess of $100,000.

In addition to assessing these patients, Dr. M. Leann Dodd and colleagues, from the Rochester, Minnesota-based medical center, conducted a systematic review of previous case reports linking gambling and Parkinson’s disease.

Parkinson’s disease is a disease of the central nervous system that causes problems with body motions, including tremor (shakiness), rigidity (muscle stiffness), slowed body movements, unstable posture and difficulty walking. It happens when nerve cells (neurons) in a part of the brain called the substantia nigra gradually die. These cells normally produce dopamine, a chemical that helps to relay messages between areas of the brain that control body movement. The death of cells in this area of the brain leads to abnormally low levels of dopamine, which makes it difficult for a person with Parkinson’s disease to control muscle tension and muscle movement, both at rest and during periods of activity.

All of the subjects were receiving therapeutic doses of a “dopamine agonist” drug, the mainstay of treatment for Parkinson’s diseases. In all but two cases, the agonist was pramipexole. In the medical literature, pramipexole was cited in 10 of 17 case reports describing pathologic gambling in patients with Parkinson’s disease.

In seven patients, the pathologic gambling began within three months of starting the drug or changing the dose, the report indicates. In the remaining four patients, the period between the start of treatment and the gambling behavior was longer, but the gambling stopped after the drug was discontinued.

In the packaging insert for Mirapex, the trade name Boehringer Ingelheim Pharmaceuticals markets pramipexole under, pathological gambling is listed as a side effect seen on post-marketing surveillance.

SOURCE: Archives of Neurology, September 2005.

Provided by ArmMed Media
Revision date: July 7, 2011
Last revised: by Jorge P. Ribeiro, MD



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