ergoline and Gambling

The orbitofrontal cortex and the dopaminergic system are structures involved in managing impulsivity and sensibility to reinforcements, and both are typically impaired in Parkinson's disease (PD). Also, l-DOPA treatment can contribute to the development of the 'Dopamine Dysregulation Syndrome', a syndrome that can influence the patients' personality and lead to risk-taking behaviors. In this study, we describe the case of a 42-year-old woman (LT) affected by juvenile PD, treated with both l-DOPA and dopamine agonists, who showed a sudden onset of pathological gambling (PG), as the only neuropsychiatric symptom. We assessed LT with a full neuropsychological battery and the Iowa Gambling Task (IGT), in order to describe her specific failure in decision making. LT's performance on the IGT is compared with that of 15 non-demented PD patients under therapy with dopamine agonists and no behavioral dysregulations and with that of 16 age- and education-matched healthy subjects. Results showed fully preserved memory, executive functions, and reasoning abilities for LT, but a remarkable and stable impairment in the IGT. Performance of LT on the IGT is significantly lower than that of both control groups. This case shows, for the first time, that high cognitive functioning and preserved executive functions are no guarantee for advantageous decision making, and that the onset of PG is consistent with selective orbitofrontal disruption and side-effects of dopamine agonist therapy. It is also showed that the IGT is a useful neuropsychological device to detect specific risk-taking behaviors, which compromise functioning in real life.

Topics: Adult; Antiparkinson Agents; Benzothiazoles; Cabergoline; Case-Control Studies; Compulsive Behavior; Decision Making; Dopamine Agonists; Drug Therapy, Combination; Ergolines; Female; Gambling; Humans; Levodopa; Matched-Pair Analysis; Neuropsychological Tests; Parkinsonian Disorders; Pramipexole; Reference Values

Topics: 5-alpha Reductase Inhibitors; Aged; Antiparkinson Agents; Benzothiazoles; Cabergoline; Carbidopa; Catechols; Drug Combinations; Drug Monitoring; Drug Therapy, Combination; Ergolines; Finasteride; Gambling; Humans; Levodopa; Male; Middle Aged; Nitriles; Parkinson Disease; Pramipexole; Treatment Outcome; Video Games

Problems with impulse control and pathological gambling are known as possible side effects of dopaminergic therapy in patients with Parkinson's disease. We report 2 cases of pathological gambling induced by dopamine agonists in patients without Parkinson's disease. The first patient, a 46-year-old man, was treated with ropinirole for restless legs syndrome and had lost huge amounts of money in the context of internet-based poker game. Another 46-year-old male patient developed pathological gambling under treatment with cabergoline administered for prolactinoma. The two cases implicate pathological gambling as a possible consequence of dopaminergic treatment and support the increasing evidence regarding pathological gambling as an adverse drug reaction of dopaminergic treatment, also in patients who do not suffer from Parkinson's disease.

Topics: Antiparkinson Agents; Cabergoline; Dopamine Agonists; Ergolines; Gambling; Humans; Indoles; International Classification of Diseases; Male; Middle Aged; Pituitary Neoplasms; Prolactinoma; Restless Legs Syndrome

Dopaminergic agents are commonly used and effective treatments for restless legs syndrome (RLS), a disabling sensorimotor disorder. Less known are some of the potentially disabling side effects of these treatments, particularly iatrogenic gambling addiction, as is described here. Here the authors present a 62-year-old man, with a 20-year history of RLS, who developed gambling addiction while on dopaminergic treatment. He was not forewarned of this side effect, nor was he ever screened for gambling behaviours prior to or during treatment. Eight months after discontinuation of dopaminergic treatment and after 10 sessions of cognitive-behavioural therapy for gambling addiction, his gambling behaviours have partially resolved. To our knowledge, this is the first ever first person account of this condition. To prevent the devastating consequences of gambling addiction or to minimise its impact by early intervention, the authors call for clinicians involved in treatment of RLS to follow these simple measures: screen patients for gambling behaviours prior to the onset and during dopaminergic treatment; forewarn patients of this potential side effect; and if patients screen positive, refer them to specialist gambling treatment services, in addition to making necessary changes to their medication regime.

Topics: Cabergoline; Carbidopa; Cognitive Behavioral Therapy; Dopamine Agonists; Drug Combinations; Ergolines; Gambling; Humans; Indoles; Levodopa; Male; Middle Aged; Restless Legs Syndrome; Tetrahydronaphthalenes; Thiophenes

Topics: Adult; Antiparkinson Agents; Benzothiazoles; Cabergoline; Clozapine; Ergolines; Female; Gambling; Humans; Male; Middle Aged; Parkinson Disease; Pramipexole; Selegiline; Serotonin Antagonists

Topics: Antineoplastic Agents; Cabergoline; Ergolines; Gambling; Humans; Libido; Male; Middle Aged; Pituitary Neoplasms; Prolactinoma

Topics: Antidepressive Agents; Antineoplastic Agents; Cabergoline; Citalopram; Delusions; Depressive Disorder, Major; Ergolines; Female; Gambling; Humans; Middle Aged; Pituitary Neoplasms; Prolactinoma