Managing impulse control behaviours in Parkinson's disease: Practical guidelines

British journal of hospital medicine (London, England: 2005) (Impact Factor: 0.38). 03/2013; 74(3):160-6. DOI: 10.12968/hmed.2013.74.3.160
Source: PubMed


Impulse control behaviours are increasingly recognized as serious complications of dopaminergic therapy in Parkinson's disease. This article outlines a set of practical guidelines for management of these behaviours which have been developed by five experts from neurology, psychiatry and care of the elderly.

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    • "The pharmacophore model achieved for interaction of the D 3 receptor with the synthesized compounds obtained from the imprinted nanovessel will also allow us to understand the role of this receptor subtype in producing anti-parkinson effects in the brain. Different dopamine agonists have been shown to provide a critical response to medication since practical guidelines for the useful management of Parkinson's diseases that have been previously reported and the incidence of the dopamine modulation with neurobehavioral-related side effects was able to induce the development of impulse control disorders (ICD) that have occurred most frequently [38]. The occurrence of neuropsychological behaviors during the treatment of Parkinson's patients can be linked to other neurological disorders such as restless leg syndrome and amyotrophic lateral sclerosis. "
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    ABSTRACT: In this study, we have developed a novel molecular imprinting method for the cloning of a drug with multiple templates to achieve a broad selectivity, and then produce reactive dopamine analogs. The products were produced within selective recognition sites of the artificial system prepared against dopamine (D) and serotonin (S) as a single and a mixed template. As a consequence of the functionality of the anchoring sites being was able to make proximity changes that could promote changes in the nanosized space for surface access for the reactants but avoided the non-active center of the formed nanosized assembly. The most effective analogues had a Bmax of the DS-MIP (1.0 M per g polymer) that was about twice that of the D-MIP. The receptor-ligand interaction studies revealed differences in the absorbance by the rat hypothalamus, and indicated that an additional potent hit was obvious. The dopamine analogs had a smaller space for receptor subtypes as determined by molecular docking and the implication of the selective D3 receptor agonists as well as the 5HT1b receptors, for the treatment of Parkinson's disease. The proposed model indicated a possible role from the desired fragments that had been inserted into a specific binding pocket of the protein near to the gorge rim as being the significant pharmacophore of this class. They showed good binding affinity for the 5-HT1b receptors. The screening test with a natural D1 receptor yielded a Bmax of 0.44 μM and the corresponding Kd values were 100-500 nM. Thus, this process that occurred in an artificial dopamine-imprinted receptor allowed for preclinical testing to identify possible neuroleptic agents and their neuroprotective effects hopefully with reduced side effects.
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    • "There is increasing recognition of Impulsive-Compulsive Behaviours (ICBs) in people with Parkinson's Disease (PD) [1]–[6] that include pathological gambling, compulsive shopping, hypersexuality, binge eating, punding, hobbyism, hoarding[7], kleptomania[8], impulsive smoking[9] and compulsive medication use. In clinical practice, ICBs are recognised by astute clinical enquiry and self-reporting, but many patients fail to report ICBs because of embarrassment and lack of awareness of the relationship between PD and ICBs[10]. The neurobiological mechanisms of ICBs in PD are under active investigation. "
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    ABSTRACT: Parkinson's Disease patients wore a device on the wrist that gave reminders to take levodopa and also measured bradykinesia and dyskinesia. Consumption of medications was acknowledged by placing the thumb on the device. Some patients performed this acknowledgement repeatedly and unconsciously. This study examines whether this behaviour reflected increased impulsivity. Twenty five participants were selected because they had i) excess acknowledgements described above or ii) Impulsive-Compulsive Behaviours or iii) neither of these. A blinded assessor applied clinical scales to measure Impulsive-Compulsive Behaviours, cognition, depression, anxiety and apathy. A Response Ratio, representing the number of acknowledgements/number of doses (expressed as a percentage) was tightly correlated with ratings of Impulsive-Compulsive Behaviours (r(2) = 0.79) in 19/25 subjects. Some of these patients had dyskinesia, which was higher with extraneous responses than with response indicating medication consumption. Six of the 25 subjects had high Impulsive-Compulsive Behaviour Scores, higher apathy scores, low levels of dyskinesia and normal Response Ratios. Patients without ICB (low RR) also had low dyskinesia levels regardless of the relevance of the response. An elevated Response Ratio is a specific measure of a type of ICB where increased incentive salience is attributed to cues by the presence of high striatal dopamine levels, manifested by high levels of dyskinesia. This study also points to a second form of ICBs which occur in the absence of dyskinesia, has normal Response Ratios and higher apathy scores, and may represent prefrontal pathology.
    PLoS ONE 02/2014; 9(2):e89319. DOI:10.1371/journal.pone.0089319 · 3.23 Impact Factor
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    ABSTRACT: Background: Clinical practice guidelines are documents used for decision-making in patient clinical care and even for health-policy development. We consider the assessment of their methodological quality is essential. Objective: To assess the methodological quality of the most recent evidence-based guidelines for the diagnosis and treatment of Parkinson’s disease. Methods: We conducted a systematic review of guidelines on Parkinson's disease published from June 2008 to June 2014. Eligible guidelines were critically evaluated by different reviewers using the Appraisal of Guidelines Research and Evaluation II (Appraisal of Guidelines for Research and Evaluation II, AGREE II). Results: A total of 26 references were obtained, from where 16 were eligible for critical evaluation. A total of 14 guidelines were considered scientifically admissible. Overall, the domain of applicability obtained the lowest scores. Top rated domain was clarity of presentation. SIGN and NICE guidelines were scored higher among all evaluated guidelines. Conclusion: A large number of guidelines were deemed admissible, however most of them require an update. The methodological quality of the guidelines varies widely, so it is suggested that developers guide agencies adhere to accepted methodological standards including the AGREE II instrument.
    Revista Mexicana de Neurociencia 10/2014; 15(6):335-344.
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