Pathological Gambling Caused by Drugs Used to Treat Parkinson Disease

TLDR

Pathological gambling is a rare but recognized complication of Parkinson disease treatment, though its underlying causes remain poorly understood. The study aimed to investigate the association between Parkinson disease medical therapy and the emergence of pathological gambling. In a routine movement disorders clinic from 2002 to 2004, 11 Parkinson disease patients who developed pathological gambling were evaluated for their medication regimens and compared with cases from a systematic literature review. All 11 patients were receiving dopamine agonists—pramipexole in 9—and gambling typically appeared within three months of initiating or increasing the drug; in four cases it resolved after discontinuation, suggesting a potentially reversible effect linked to D3 receptor stimulation. Published online July 11, 2005 (doi:10.1001/archneur.62.9.noc50009).

Abstract

<h3>Background</h3> Pathological gambling is a rare potential complication related to treatment of Parkinson disease (PD). However, the etiology of this behavior is poorly understood. <h3>Objective</h3> To examine the relationship between medical therapy for PD and pathological gambling. <h3>Methods</h3> In our routine movement disorders practice (2002-2004), we encountered 11 patients with idiopathic PD who had recently developed pathological gambling. We assessed the relationship to their medical therapy and compared them with cases identified by systematic review of the existing literature on pathological gambling and PD. <h3>Results</h3> All 11 patients with PD and pathological gambling were taking therapeutic doses of a dopamine agonist; 3 of these patients were not treated with levodopa. In 7 patients, pathological gambling developed within 3 months of starting to take or escalating the dose of the agonist; in the other 4 with a longer latency, gambling resolved after the agonist use was discontinued. Pramipexole dihydrochloride was the agonist in 9 of 11 cases in our series and 10 of 17 in the literature (68% in total). <h3>Conclusions</h3> Dopamine agonist therapy was associated with potentially reversible pathological gambling, and pramipexole was the medication predominantly implicated. This may relate to disproportionate stimulation of dopamine D₃receptors, which are primarily localized to the limbic system. Published online July 11, 2005 (doi:10.1001/archneur.62.9.noc50009).