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Possible Treatment for Pathological Gambling in Parkinsonís Disease
- Sep 16 2010
Amantadine may be effective in treating pathological gambling, an impulse control disorder that can develop in people with Parkinson’s disease (PD) as a side effect of other medications, according to a report in the September 2010 issue of Annals of Neurology.
Earlier studies have found that about five percent of people taking Carbidopa/levodopa (Sinemet®) and 17 percent of those taking dopamine agonists such as pramipexole (Mirapex®) or ropinirole (Requip®) develop irresistible and destructive impulses, including compulsive shopping, eating, hypersexuality and gambling. To treat pathological gambling, doctors usually lower a person’s dose of dopamine agonist. This can reduce the gambling behavior, but also cause troublesome motor symptoms to return. In addition, tapering off dopamine agonists in people with impulse control disorder can be very difficult.
In the new study, Astrid Thomas, M.D., Ph.D., and other researchers working in the laboratory of Marco Onofrj, M.D., at the University G. d’Annunzio in Chieti, Italy, tested whether the drug amantadine reduced pathological gambling in people with PD. The 17 study participants ranged in age from 53 to 74; 13 were men and four were women; the severity of their Parkinson’s ranged from early to mid-stage. All played instant lottery scratch games, and six participants also gambled on slot machines.
Over the course of the 17-week, double-blinded study, participants were monitored first while taking only their usual medications, then while taking these medications plus amantadine, and finally while taking their usual medications plus a placebo. Participants also kept diaries of how much time and money they spent gambling.
- When participants started taking amantadine, their compulsive gambling behavior was markedly reduced within a few days.
- Seven of twelve participants stopped gambling completely while taking amantadine.
- The other five participants greatly reduced their time spent gambling and the amount of money lost while taking amantadine.
- Five participants (29 percent) dropped out of the study because of the side effects of amantadine, which included confusion and visual hallucinations.
- When participants stopped taking amantadine, their compulsive gambling behavior returned within a few days.
What Does it Mean?
Impulse control disorders can be very disabling. Compulsive gambling in particular can be very disruptive to the lives and finances of people with PD and their families. First line interventions should include tapering dopamine agonists and behavioral therapy. Amantadine may be a useful treatment for compulsive gambling in those who cannot tolerate discontinuing dopaminergic therapy. However, this is a small study and about one-third of all participants were unable to tolerate the drug. Therefore, a larger study is needed to better understand and confirm efficacy of amantadine.
Learn more about impulse control disorders by reading a recent interview that PDF conducted with Daniel Weintraub, M.D.
Reference: Thomas A, Bonanni L, Gambi F, Di Iorio A, Onofrj M. Pathological gambling in Parkinson disease is reduced by amantadine. Ann Neurol. 2010 Sep;68(3):400-4. (http://www.ncbi.nlm.nih.gov/pubmed/20687121)
Source Date: Sep 16 2010