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Abstract Details

Dopamine Dysregulation Syndrome in Parkinson’s Disease and its Management with Advanced Therapies
Movement Disorders
P9 - Poster Session 9 (12:00 PM-1:00 PM)
3-015

To characterize the DDS population at our tertiary centre, determine the risk factors that predispose to DDS and interventional strategies that facilitate its recovery.
Dopamine Dysregulation Syndrome (DDS) is an adverse non-motor complication of dopamine replacement therapy in Parkinson’s Disease. The current literature on DDS is limited, and it remains underdiagnosed and challenging to manage.

We performed a retrospective chart review and identified 27 patients who fit the inclusion criteria for DDS. They were classified according to risk factors that have been identified in the literature, UPDRS motor and complication scores, intervention (medical or surgical) and outcome. Univariate analyses were performed to quantify these characteristics.

Of the 27 patients, 23 were male and 4 were female. Mean age of onset was 49 years, and average duration of PD was 15.9 years. Average reported levodopa equivalent daily dose was 1916.7mg. A history of prior psychiatric illness was identified in 70% of patients, impulse control disorder in 89% and substance abuse in 3.7%. Interventions included reduction of dopamine therapy (88.9%), deep brain stimulation (DBS) of the subthalamic nucleus (STN, 48.1%) or globus pallidus interna (GPi, 7.4%), and levodopa-carbidopa intestinal gel (LCIG) infusion (11.1%). Baseline UPDRS IV before treatment and MDS III after treatment were not significant between intervention groups (p=0.09 and p=0.13 respectively). Overall 88.9% patients improved at follow up, with medication only (75%), STN DBS (100%), GPi DBS (100%) and LCIG (33%). Relapse rate was 18.2%, in the STN group only.
The characteristics of our patient population are reflective of what has been described in the DDS literature. Our results suggest that GPi DBS, in concurrence with dopaminergic medication reduction, is the most effective intervention. STN DBS might be also beneficial, although the associated medication reduction causes DDS relapse in a subgroup of patients.
Authors/Disclosures
Sanskriti Sasikumar, MD (University of Toronto)
PRESENTER 		Dr. Sasikumar has nothing to disclose.
No disclosure on file
Renato P. Munhoz, MD, PhD Dr. Munhoz has nothing to disclose.
No disclosure on file
No disclosure on file
Andres M. Lozano, MD (Toronto Western Hosp) Dr. Lozano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. Dr. Lozano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Insightec. Dr. Lozano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. Dr. Lozano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Dr. Lozano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Functional Neuromodulation.
Suneil Kalia Suneil Kalia has received personal compensation in the range of $0-$499 for serving as a Consultant for Abbott. Suneil Kalia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston. Suneil Kalia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Suneil Kalia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novonordisk. The institution of Suneil Kalia has received research support from CIHR. Suneil Kalia has received research support from MJFF. The institution of Suneil Kalia has received research support from Parkinson Canada.
No disclosure on file
Alfonso Fasano, MD, PhD, FÂ鶹´«Ã½Ó³»­ (Toronto Western Hospital - U of Toronto) Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott. Dr. Fasano has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ipsen. Dr. Fasano has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Fasano has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceregate. Dr. Fasano has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Inbrain Neuroelectronics. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Syneos Health. Dr. Fasano has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Annovis. Dr. Fasano has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for CADTH. Dr. Fasano has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for International Parkinson and Movement Disorders Society. The institution of Dr. Fasano has received research support from Boston Scientific. The institution of Dr. Fasano has received research support from Medtronic. The institution of Dr. Fasano has received research support from Abbvie. The institution of Dr. Fasano has received research support from Canadian Institutes of Health Research (CIHR). The institution of Dr. Fasano has received research support from Michael J Fox Foundation. The institution of Dr. Fasano has received research support from Bluerock Therapeutics. Dr. Fasano has received publishing royalties from a publication relating to health care. Dr. Fasano has a non-compensated relationship as a Medical Advisory Committee with CenteR for Advancing Neurological Innovation to Application (CRANIA) that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Fasano has a non-compensated relationship as a Medical Advisory Committee with HopeNET that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Fasano has a non-compensated relationship as a Medical Advisory Committee with International Essential Tremor Foundation that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Fasano has a non-compensated relationship as a Member with Tremor Research Group that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Fasano has a non-compensated relationship as a Co-Chair with Tremor Study Group of the IPMDS that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Fasano has a non-compensated relationship as a Vice-Chair with NPH Study Group of the IPMDS that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Fasano has a non-compensated relationship as a Vice-Chair with Industry Committee of the IPMDS that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.