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Dopamine Dysregulation Syndrome — SCE Neurology MCQ

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HardMovement DisordersDopamine Dysregulation SyndromeSCE Neurology

A patient taking pramipexole develops compulsive gambling with major financial harm. Previous abrupt omission caused anxiety, sweating, pain and profound dysphoria despite adequate levodopa. Which management plan best addresses both the impulse-control disorder and withdrawal risk?

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Correct answer: B — Taper pramipexole with specialist supervision while monitoring behaviour and withdrawal symptoms

This is a problematic impulse-control disorder caused by dopaminergic therapy, with a history strongly suggestive of dopamine-agonist withdrawal syndrome. NICE advises specialist input and first gradually reducing the dopamine agonist while monitoring both behavioural improvement and withdrawal symptoms. Adequate levodopa does not reliably prevent the psychiatric and autonomic withdrawal syndrome. Specialist CBT may be offered if medication modification is ineffective, but it does not replace removal of the precipitating drug.

Reference: NICE NG71: Parkinson’s disease in adults — recommendations. https://www.nice.org.uk/guidance/ng71/chapter/Recommendations