Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Managing impulse control and related behavioral disorders in Parkinson’s disease : where we are in 2025?

Rigon, Leonardo ; Fogliano, Carmelo ; Chaudhuri, K. Ray ; Poplawska-Domaszewicz, Karolina ; Falup-Pecurariu, Cristian ; Murasan, Iulia ; Wolfschlag, Mirjam LU ; Odin, Per LU orcid and Antonini, Angelo (2025) In Expert Review of Neurotherapeutics 25(5). p.537-554
Abstract

Introduction: Impulse control and related behavioral disorders (ICBDs) commonly complicate Parkinson’s disease (PD) course. The ICBDs spectrum encompasses two groups of conditions, with distinct pathophysiology: proper ‘impulse control disorders (ICDs)’ (e.g. gambling) and the ‘ICDs related disorders (ICDs-RD)’ (e.g. punding). Behavioral disturbances are associated with dopamine replacement therapies. ICBDs affect quality of life of patients and caregivers, making their management essential for reducing PD overall burden. Areas covered: This article reviews current management strategies for ICBDs in PD. The authors highlight strengths and limitations of these strategies, and explore the potential role of emerging treatment options,... (More)

Introduction: Impulse control and related behavioral disorders (ICBDs) commonly complicate Parkinson’s disease (PD) course. The ICBDs spectrum encompasses two groups of conditions, with distinct pathophysiology: proper ‘impulse control disorders (ICDs)’ (e.g. gambling) and the ‘ICDs related disorders (ICDs-RD)’ (e.g. punding). Behavioral disturbances are associated with dopamine replacement therapies. ICBDs affect quality of life of patients and caregivers, making their management essential for reducing PD overall burden. Areas covered: This article reviews current management strategies for ICBDs in PD. The authors highlight strengths and limitations of these strategies, and explore the potential role of emerging treatment options, giving particular focus to new compounds and invasive therapies. Expert opinion: Prevention, close monitoring, and caregiver involvement are essential in managing ICBDs in PD. Treatment approaches should be tailored to ICBDs’ functional impact and aimed to reduce the pulsatile stimulation of dopamine receptors, especially D2. Dopamine agonist (DA) tapering remains the primary therapeutic approach, alongside psychotherapy and second-line agents, like atypical antipsychotics and serotonin-noradrenaline reuptake inhibitors. Insights into ICDs pathophysiology and DA-specific pharmacodynamics indicate safer profiles for certain preparations (e.g. rotigotine patches) and possibly for D1/D5 agonists like tavapadon. Invasive treatments, including deep brain stimulation and infusion therapies, should be prioritized in advanced-stage PD complicated by ICBDs.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
dopamine agonist, dopamine agonist withdrawal syndrome, dopamine dysregulation syndrome, dopamine replacement therapy (DRT), impulse control disorders, Parkinson’s disease, punding
in
Expert Review of Neurotherapeutics
volume
25
issue
5
pages
18 pages
publisher
Future Drugs Ltd
external identifiers
  • pmid:40152930
  • scopus:105002389933
ISSN
1473-7175
DOI
10.1080/14737175.2025.2485337
language
English
LU publication?
yes
id
f4b36977-5461-40cf-8465-b5afe88fb8a1
date added to LUP
2025-09-01 13:17:35
date last changed
2025-09-02 02:22:43
@article{f4b36977-5461-40cf-8465-b5afe88fb8a1,
  abstract     = {{<p>Introduction: Impulse control and related behavioral disorders (ICBDs) commonly complicate Parkinson’s disease (PD) course. The ICBDs spectrum encompasses two groups of conditions, with distinct pathophysiology: proper ‘impulse control disorders (ICDs)’ (e.g. gambling) and the ‘ICDs related disorders (ICDs-RD)’ (e.g. punding). Behavioral disturbances are associated with dopamine replacement therapies. ICBDs affect quality of life of patients and caregivers, making their management essential for reducing PD overall burden. Areas covered: This article reviews current management strategies for ICBDs in PD. The authors highlight strengths and limitations of these strategies, and explore the potential role of emerging treatment options, giving particular focus to new compounds and invasive therapies. Expert opinion: Prevention, close monitoring, and caregiver involvement are essential in managing ICBDs in PD. Treatment approaches should be tailored to ICBDs’ functional impact and aimed to reduce the pulsatile stimulation of dopamine receptors, especially D2. Dopamine agonist (DA) tapering remains the primary therapeutic approach, alongside psychotherapy and second-line agents, like atypical antipsychotics and serotonin-noradrenaline reuptake inhibitors. Insights into ICDs pathophysiology and DA-specific pharmacodynamics indicate safer profiles for certain preparations (e.g. rotigotine patches) and possibly for D1/D5 agonists like tavapadon. Invasive treatments, including deep brain stimulation and infusion therapies, should be prioritized in advanced-stage PD complicated by ICBDs.</p>}},
  author       = {{Rigon, Leonardo and Fogliano, Carmelo and Chaudhuri, K. Ray and Poplawska-Domaszewicz, Karolina and Falup-Pecurariu, Cristian and Murasan, Iulia and Wolfschlag, Mirjam and Odin, Per and Antonini, Angelo}},
  issn         = {{1473-7175}},
  keywords     = {{dopamine agonist; dopamine agonist withdrawal syndrome; dopamine dysregulation syndrome; dopamine replacement therapy (DRT); impulse control disorders; Parkinson’s disease; punding}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{537--554}},
  publisher    = {{Future Drugs Ltd}},
  series       = {{Expert Review of Neurotherapeutics}},
  title        = {{Managing impulse control and related behavioral disorders in Parkinson’s disease : where we are in 2025?}},
  url          = {{http://dx.doi.org/10.1080/14737175.2025.2485337}},
  doi          = {{10.1080/14737175.2025.2485337}},
  volume       = {{25}},
  year         = {{2025}},
}