ARTICLE: Parkinson's Medication Linked To Gambling

[Murray Charters <mcharters@xxxxxxxxxxxxxx>]

EurekAlert, DC
Public release date: 11-Aug-2003
Contact: Marilee Reu
mreu@xxxxxxx
651-695-2789
American Academy of Neurology

Parkinson's medication linked to gambling

ST. PAUL, MN ? Excessive gambling could be an unfortunate yet rare side effect 
in Parkinson's patients who take certain
dopamine agonists, according to a study in the August 12 issue of Neurology, 
the scientific journal of the American
Academy of Neurology.

Researchers at Muhammad Ali Parkinson Research Center in Phoenix, Ariz., 
examined the data of 1,884 Parkinson's
patients who were seen during a one-year period. Nine patients ? seven men and 
two women ? were identified with
pathological gambling.

"The risk of gambling problems in a Parkinson's patient is very small," said 
study author Mark Stacy, MD, who is now
the medical director of the Parkinson's Disease and Movement Disorders Center 
at Duke University Medical Center,
Durham, N.C. "However, it may be appropriate for doctors to inform patients of 
this potential risk, particularly in
their patients taking relatively high dosages of a dopamine agonist, and with a 
documented history of depression or
anxiety disorder."

The nine patients were taking both levodopa (a drug that the brain transforms 
into dopamine) and a dopamine agonist (a
drug that activates the dopamine receptor in the brain). Eight of the patients 
took pramipexole as their dopamine
agonist, and one patient was on pergolide. None of the other patients taking 
ropinirole (a different dopamine agonist)
or only levodopa were identified with a gambling problem.

Most of the patients were in advanced stages of the disease. On average, they 
had been diagnosed with Parkinson's for
more than 11 years before gambling problems began. The patients were taking 
pramipexole or pergolide anywhere from six
to 64 months before the onset of gambling, and seven patients started gambling 
within one month of an increased dosage
of the dopamine agonist. None of them had a previous history of gambling.

The gambling behavior was severe enough to cause financial problems, and two 
patients had losses more than $60,000.
After a family member or caregiver noticed substantial financial loss, the 
patients' treatment regimen was changed.

For most patients, the gambling could be controlled or stopped under a new 
treatment plan. Eight patients had the
dopamine agonist switched to lower comparative dosages of ropinirole, and the 
remaining patient received a decreased
dosage of pramipexole and an increased dosage of levodopa. Some patients also 
attended Gamblers Anonymous meetings.
Caregivers secured patients' credit cards and watched for signs of a gambling 
relapse.

Two of the patients who switched to ropinirole also required additional 
psychiatric treatment, and one withdrew from
the therapy program and later committed suicide, while dealing with a number of 
issues unrelated to her Parkinson's
disease.

The rate of pathological gambling found in the 529 subjects taking pramipexole 
(1.5 percent) is only slightly higher
than the reported rate in the general population (.3 to 1.3 percent), and the 
availability of casinos in a retirement
and vacation setting like Arizona may have contributed to the development of 
this behavior in the patients, Stacy
noted.

"However, this clinical observation suggests that higher dosages of dopamine 
agonists may be a catalyst to bringing out
this destructive behavior," said Stacy.

Dopamine is a chemical substance produced in the brain that enables people to 
move smoothly. Parkinson's patients have
a severe shortage of dopamine, which results in symptoms including tremor, 
rigidity and walking problems.

###

The American Academy of Neurology, an association of more than 18,000 
neurologists and neuroscience professionals, is
dedicated to improving patient care through education and research. A 
neurologist is a doctor with specialized training
in diagnosing, treating and managing disorders of the brain and nervous system 
such as stroke, Alzheimer's disease,
epilepsy, Parkinson's disease, autism and multiple sclerosis.

For more information about the American Academy of Neurology, visit its website 
at 

SOURCE: EurekAlert, DC


* * *

----------------------------------------------------------------------
To sign-off Parkinsn send a message to: mailto:listserv@xxxxxxxxxxxxxxxxxxxx
In the body of the message put: signoff parkinsn