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We read with interest the article by Dodd et al.¹ Impulse control disorders associated with dopaminergic drugs in Parkinson disease (PD) are fascinating and of considerable clinical importance. This report, however, focuses on dopamine agonists and especially pramipexole. Although dopamine agonists are more commonly implicated in impulse control disorders, we would like to point out that levodopa is associated with similar behaviors as well.^2-4

Three years after the introduction of levodopa, Andén et al² reported a man with PD who developed compulsive hammering of nails into the doors and walls after his dose of levodopa was increased. The punding behavior resolved when his levodopa dose was lowered.² This report precedes the use of dopamine agonists in PD. Levodopa was also associated with pathological gambling in a series of 12 patients reported by Molina et al.³ The gambling compulsion occurred typically in the "on" state for these patients and would frequently . . . [Full Text of this Article]

AUTHOR INFORMATION

John C. Morgan, MD, PhD; Sanjay S. Iyer, MD; Kapil D. Sethi, MD, FRCP(UK)

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