Levodopa Dose in Parkinson's Linked to Compulsive Sexual Behavior

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Patients who received higher doses of levodopa were more likely to experience compulsive sexual behaviors.
Patients who received higher doses of levodopa were more likely to experience compulsive sexual behaviors.

Compulsive sexual behavior (CSB) appears to be more frequent in men with Parkinson disease (PD) and is possibly fueled by high levodopa doses, according to findings from a database analysis published in the Journal of Neurology, Neurosurgery, and Psychiatry.

The investigators identified patients with PD with impulsive compulsive behaviors (ICBs) from a database of patients seen at a hospital in the United Kingdom (n=111). Participants included in the final analysis had been involved in 3 research projects from 2008 to 2016 and were categorized as having CSB ([CSB+] n=55) or not having CSB ([CSB-] n=56).

Approximately half (49.5%) of participants had CSB, whereas 43.2% were diagnosed with punding, 38.7% were compulsive shoppers, 32.4% were pathological gamblers, 24.3% had dopamine dysregulation syndrome, and 19.8% were compulsive eaters.

There was a greater percentage of men in the CSB+ vs CSB- arm (P <.001). In CSB+ men, ICBs occurred at a significantly younger age compared with CSB– participants (P =.02). There were no differences between the 2 CSB groups with regard to the percentage of participants using monoamine oxidase inhibitors (MAOi), amantadine or catechol-O-methyl transferase inhibitors (COMTi), dopamine agonists (DAs), or levodopa.

Of note, individuals with CSB were being given a higher levodopa dose and more dopaminergic treatment than CSB– individuals (P =.014). In addition, CSB+ participants were using a significantly higher levodopa daily dose (P =.043), greater combined levodopa and COMTi LEDD (P =.039), and more isolated COMTi LEDD (P =.026).

Due to only including patients who participated in the previous 3 researcher projects, the researchers suggest that they may have missed patients with ICB who received a diagnosis during a routine outpatient appointment.

Based on the findings, the investigators also believe that higher COMTi doses “are not directly related to ICBs but are rather contributing to excessive dopaminergic stimulation by increasing the bioavailability of levodopa.”

Reference

Barbosa PM, Grippe T, Lees AJ, et al. Compulsive sexual behaviour in Parkinson's disease is associated with higher doses of levodopa [published online November 24, 2017]. J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp-2017-317298

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