Assessment of therapeutic strategies for management of impulse control disorder in Parkinson’s disease

ABSTRACT Background: Impulse control disorders (ICD) occur frequently in individuals with Parkinson's disease. So far, prevention is the best treatment. Several strategies for its treatment have been suggested, but their frequency of use and benefit have scarcely been explored. Objective: To investigate which strategy is the most commonly used in a real-life setting and its rate of response. Methods: A longitudinal study was conducted. At the baseline evaluation, data on current treatment and ICD status according to QUIP-RS were collected. The treatment strategies were categorized as “no-change”, dopamine agonist (DA) dose lowering, DA removal, DA switch or add-on therapy. At the six-month follow-up visit, the same tools were applied. Results: A total of 132 individuals (58.3% men) were included; 18.2% had at least one ICD at baseline. The therapeutic strategy most used in the ICD group was no-change (37.5%), followed by DA removal (16.7%), DA switch (12.5%) and DA lowering (8.3%). Unexpectedly, in 20.8% of the ICD subjects the DA dose was increased. Overall, nearly 80% of the subjects showed remission of their ICD at follow-up. Conclusions: Regardless of the therapy used, most of the subjects presented remission of their ICD at follow-up Further research with a longer follow-up in a larger sample, with assessment of decision-making processes, is required in order to better understand the efficacy of strategies for ICD treatment.

摘要：背景：冲动控制障碍（Impulse Control Disorders, ICD）在帕金森病患者中较为高发。目前，预防仍是其最佳治疗手段。尽管已有多项治疗策略被提出，但相关策略的临床应用频率与实际获益情况却鲜有探索。目的：探究临床真实诊疗场景中最常用的治疗策略及其症状应答率。方法：本研究为纵向队列研究。基线评估阶段，收集受试者当前的治疗方案及依据QUIP-RS量表评定的冲动控制障碍患病状态。治疗策略被划分为「维持原治疗方案」、多巴胺受体激动剂（Dopamine Agonist, DA）减量、停用DA、DA换药或DA联合治疗。在6个月随访访视中，重复采用相同工具进行评估。结果：共纳入132例受试者（男性占比58.3%）；基线时18.2%的受试者至少存在1种冲动控制障碍症状。在冲动控制障碍亚组中，最常用的治疗策略为维持原治疗方案（37.5%），其次为停用DA（16.7%）、DA换药（12.5%）与DA减量（8.3%）。出乎意料的是，20.8%的冲动控制障碍受试者接受了DA剂量提升治疗。总体而言，近80%的受试者在随访时实现了冲动控制障碍症状缓解。结论：无论采用何种治疗策略，大部分受试者在随访时均实现了冲动控制障碍症状缓解。未来仍需开展更大样本量、更长随访周期的研究，并结合决策过程评估，以进一步明确冲动控制障碍治疗策略的临床疗效。