Use of Requip and Mirapex in 3 Path-confirmed PSP Cases

This UK team, most of whom are at the University College London, is probably top in the world in terms of clinical-pathological correlations on PSP.

This recently-published article is about three cases of pathologically confirmed PSP who developed impulsive-compulsive spectrum behaviors (ICBs) when taking dopamine agonists (DA). Dopamine agonists are Requip (ropinirole) and Mirapex (pramipexole).

In one case, the brain pathology was consistent with PSP-parkinsonism. (During life, that case was diagnosed clinically with PD.) In the two other cases, the brain pathology was consistent with Richardson’s syndrome. (These are the two most common types of PSP.) “All cases had some degree of vascular pathology, minimal Alzheimer-type pathology, and Lewy body pathology was absent.”

Quite a bit has been published about the ICBs that can occur in PD when dopamine agonists are used; these ICBs include “pathological gambling, hypersexuality, compulsive shopping, binge eating, punding and compulsive use of” dopamine replacement therapy. About 14% of those with PD who use dopamine agonists develop ICBs.

(“Punding” is the compulsive performance of a repetitive, purposeless activity. It could include collecting things and arranging them in a very precious manner. Or disassembling something and putting it together again and again.)

The authors conclude: “Our cases are notable for the relatively early development of ICBs on DA, whereas in the PD ICB literature, longer treatment duration are described. … Our cases add to the argument that DA themselves can be a major risk factor for the development of ICBs, irrespective of the underlying pathological reason for their use. .. Extra caution regarding ICBs is required amongst clinicians considering DA use in PSP.

I’ve copied the abstract below.


Movement Disorders. 2010 Mar 8. [Epub ahead of print]

Impulsive-compulsive spectrum behaviors in pathologically confirmed progressive supranuclear palsy.

O’Sullivan SS, Djamshidian A, Ahmed Z, Evans AH, Lawrence AD, Holton JL, Revesz T, Lees AJ.
Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, United Kingdom.

There is growing awareness of impulsive-compulsive spectrum behaviors (ICBs) in patients with Parkinson’s disease (PD) treated with dopamine replacement therapy (DRT). These include pathological gambling, hypersexuality, compulsive shopping, binge eating, punding and compulsive use of DRT, or dopamine dysregulation syndrome. In PD, difficulties exist in separating the effects of DRT from the underlying disease process and aberrant dopaminergic systems in determining the aetiology of ICBs. Recent reports of ICBs associated with dopamine agonist use for conditions other than PD may suggest a significant etiological role for these medications, but currently published cases thus far lack pathological confirmation of diagnoses. We present three cases of pathologically confirmed progressive supranuclear palsy who developed ICBs in association with dopamine agonist use. Pathological comparisons between these three cases and other case series of progressive supranuclear palsy are made.

PubMed ID#: 20213825 (see for this abstract only)