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Myoclonus from Creutzfeldt-Jakob disease — SCE Neurology MCQ

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HardMovement DisordersMyoclonus from Creutzfeldt-Jakob diseaseSCE Neurology

A 59-year-old with Parkinson disease takes pramipexole and levodopa. His motor symptoms are controlled, but his partner discovers concealed online gambling, hypersexual behaviour and substantial debt. He asks to stop pramipexole immediately. What is the most appropriate next management step?

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Correct answer: D — Plan gradual pramipexole reduction with the Parkinson team, monitoring behaviour and withdrawal symptoms

This is a problematic impulse-control disorder associated with a dopamine agonist. NICE recommends seeking advice from a Parkinson specialist before modifying therapy, then first gradually reducing the dopamine agonist while monitoring both improvement in the behaviour and dopamine-agonist withdrawal symptoms. Abrupt cessation can cause a clinically important withdrawal syndrome. Switching to another dopamine agonist preserves the likely driver, and specialist cognitive behavioural therapy is offered when dopaminergic modification has not been effective rather than replacing that first step.

Reference: NICE NG71, managing impulse-control disorders: https://www.nice.org.uk/guidance/ng71/chapter/Recommendations