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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2022; 80(01): 56-61
DOI: 10.1590/0004-282X-ANP-2020-0522
Article

The prevalence of impulsive compulsive behaviors in patients treated with apomorphine infusion: a retrospective analysis

Prevalência de comportamentos impulsivo-compulsivos em pacientes tratados com infusão de apomorfina: análise retrospectiva
Pedro Barbosa 
1   University College London, Institute of Neurology, Reta Lila Weston Institute of Neurological Studies, London, UK.
2   University College London, Institute of Neurology, Queen Square Brain Bank for Neurological Disorders, London, UK.
,
Atbin Djamshidian 
1   University College London, Institute of Neurology, Reta Lila Weston Institute of Neurological Studies, London, UK.
3   Innsbruck Medical University, Department of Neurology, Innsbruck, Austria.
,
Andrew John Lees 
1   University College London, Institute of Neurology, Reta Lila Weston Institute of Neurological Studies, London, UK.
2   University College London, Institute of Neurology, Queen Square Brain Bank for Neurological Disorders, London, UK.
,
Thomas Treharne Warner 
1   University College London, Institute of Neurology, Reta Lila Weston Institute of Neurological Studies, London, UK.
2   University College London, Institute of Neurology, Queen Square Brain Bank for Neurological Disorders, London, UK.
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ABSTRACT

Background: Impulsive compulsive behaviors (ICBs) can affect a significant number of Parkinson’s disease (PD) patients. Objective: We have studied brain samples from a brain bank of PD patients who received apomorphine via continuous infusion in life to assess the prevalence and outcome of ICBs. Methods: A search on the Queen Square Brain Bank (QSBB) database for cases donated from 2005 to 2016 with a pathological diagnosis of idiopathic PD was conducted. Notes of all donors who used apomorphine via continuous infusion for at least three months were reviewed. Clinical and demographic data were collected, as well as detailed information on treatment, prevalence and outcomes of ICBs. Results: 193 PD cases, 124 males and 69 females, with an average age at disease onset of 60.2 years and average disease duration of 17.2 years were reviewed. Dementia occurred in nearly half of the sample, depression in one quarter, and dyskinesias in a little over 40%. The prevalence of ICBs was 14.5%. Twenty-four individuals used apomorphine infusion for more than three months. Patients on apomorphine had younger age at disease onset, longer disease duration, and higher prevalence of dyskinesias. The prevalence of de novo ICB cases among patients on apomorphine was 8.3%. Apomorphine infusion was used for an average of 63.1 months on an average maximum dose of 79.5 mg per day. Ten patients remained on apomorphine until death. Conclusions: Apomorphine can be used as an alternative treatment for patients with previous ICBs as it has low risk of triggering recurrence of ICBs.

RESUMO

Antecedentes: Comportamentos impulsivo-compulsivos (CICs) podem acometer uma parcela significativa de indivíduos com doença de Parkinson (DP). Objetivo: Nós estudamos amostras de tecido cerebral de uma população de pacientes com DP de um banco de cérebros que receberam apomorfina por infusão contínua em vida, com a finalidade de avaliar a prevalência e o desfecho dos CICs. Métodos: Uma pesquisa no banco de dados do Banco de Cérebros de Queen Square foi conduzida à procura de doações recebidas entre 2005 e 2016 com diagnóstico anatomopatológico de DP idiopática. Os prontuários de todos os doadores que usaram apomorfina por infusão contínua por um período mínimo de três meses foram revisados. Dados clínicos e demográficos foram coletados, assim como informações detalhadas sobre o tratamento, prevalência e desfecho dos CICs. Resultados: 193 casos de DP, 124 do sexo masculino e 69 do sexo feminino, com idade média de início da doença de 60,2 anos e tempo médio de duração da doença de 17,2 anos, foram revisados. Aproximadamente metade dos casos apresentaram demência, um quarto depressão, e um pouco mais de 40% discinesias. A prevalência de CICs foi 14,5%. Vinte e quatro indivíduos usaram infusão de apomorfina por mais de três meses. Os pacientes que usaram apomorfina apresentaram DP mais cedo, maior duração da doença, e uma maior prevalência de discinesias. A prevalência de novos casos de CICs entre pacientes usando apomorfina foi de 8,3%. Infusão de apomorfina foi usada em média por 63,1 meses a um dose máxima média de 79,5 mg por dia. Dez pacientes permaneceram usando apomorfina até o óbito. Conclusões: Apomorfina pode ser usada como opção de tratamento alternativo para pacientes que apresentarem CICs no passado considerando seu baixo risco de causar recorrência de CICs.

Keywords:

Parkinson Disease - Compulsive Behavior - Impulsive Behavior - Disruptive, Impulse Control, and Conduct Disorders - Apomorphine

Palavras-chave:

Doença de Parkinson - Comportamento Compulsivo - Comportamento Impulsivo - Transtornos Disruptivos, de Controle do Impulso e da Conduta - Apomorfina

Authors’ contributions:

PB: research project - conception, organization, execution, statistical analysis - design, execution, manuscript preparation - writing of the first draft; AD: research project - conception, execution, statistical analysis and manuscript preparation - review and critique; AJL: statistical analysis and manuscript preparation - review and critique; TTW: research project - conception, statistical analysis and manuscript preparation - review and critique.




Publication History

Received: 03 November 2020

Accepted: 16 February 2021

Article published online:
30 January 2023

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