Nazlı DURMAZ ÇELİK, Müge KUZU KUMCU, Seda BOSTAN, Serhat ÖZKAN

PARKİNSON HASTALIĞI TEDAVİSİNDE İLACA BAĞLI DÜRTÜ KONTROL BOZUKLUĞU

Giriş: Dürtü kontrol bozukluğu (DKB), Parkinson hastalarında dopamin agonisti (DA) kullanımına bağlı ortaya çıkan ve %3.58- 42.8 oranında görülen bir komplikasyondur. Dürtü kontrol bozukluğu genellikle kumar oynama, aşırı alışveriş, hiperseksüalizm, aşırı yeme gibi kontrolsüz davranışlar olarak görülmektedir. Genç yaş, erkek cinsiyet, depresyon öyküsü, DKB öyküsü, tedaviye levodopa eklenmiş olması iyi bilinen risk faktörleridir. Bu çalışmanın amacı DA kullanan Parkinson hastalarımızda DKB sıklığını ve risk faktörleri ve çeşitliğini saptamaktır. Gereç ve Yöntem: Bu çalışmada kliniğimizde 2008-2019 yılları arasında başvuran dopamina gonisti (pramipeksol, ropinirol) kullanan 328 Parkinson hastasının verileri retrospektif olarak değerlendirildi. Hastaların yaşı, cinsiyeti, Hoehn&Yahr evresi, hastalık süresi, kullandığı dopaminagonisti ve kullanım süreleri, dürtü kontrol bozukluğu verileri kaydedildi. Hastalar DKB olan (DKB+) ve DKB olmayan (DKB-) olarak iki grupta incelendi. DKB’si pozitif olan hastalar tek bir DKB tipine veya birden çok tipe sahip olanlar şeklinde tekrar gruplandırıldı. Bulgular: DA kullanan 157’si kadın (%47,9), 171’i erkek (%52,1) toplam 328 hastanın 37’inde (%11,2) inde DKB gözlendi, bunların 11’i kadın, 26’sı erkekti. DKB=1 ve DKB>1 olan hastalar karşılaştırıldığında genç yaştaki hastaların DKB sayısının daha fazla olduğu saptandı. Erkek hastalarda DKB sıklığı daha yüksekti. DKB çeşidi incelendiğinde aşırı para harcama /alışveriş (%38), hiperseksualite (%24), aşırı yemek yeme (%18.4), punding ve hobizm (%9), aşırı kumar oynama (%7), internette aşırı vakit geçirme (%4), aşırı gezme (%4) görüldü. Hiperseksualite erkeklerde kadınlara oranla daha yaygın ve sıklıkla görülen DKB idi (K:E oranı = 1:13). Sonuç: Bu çalışmada biz dopamin agonisti kullanan Parkinson hastalarının %10’unda DKB görüldüğünü bulduk. Erkek cinsiyette DKB gelişme riski daha fazladır. Genç yaştaki hastalarda birden fazla DKB riski daha yüksektir. DKB gelişiminin risk faktörlerini değerlendirmek için yeni çok merkezli prospektif çalışmalara ihtiyaç vardır.

DRUG-INDUCED IMPULSE CONTROL DISORDERS IN THE TREATMENT OF PARKINSON’S DISEASE

Introduction: Impulse-control disorder (ICD) is a complication caused by the use of dopain agonist (DA) in Parkinson’s disease patients with a frequency of %3,58- %42,8. Impulse-control disorder is seen as uncontrolled behaviors commonly observed as gambling, excessive shopping, hypersexuality and excessive eating. Young age, history of depression or ICD, male gender, additional usage of levodopa are the well-established risk factors for ICD development. Our aim was to determine the frequency, risk factors and diversity of ICD in our Parkinson’s disease patients using dopamine agonists. Material and Method: In this study, data of 328 PD patients using dopamine agonists (pramipexole, ropinirole) who were admitted to our clinic between years 2008- 2019 were analyzed retrospectively. Patients’ age, gender, Hoehn&Yahr’s Stage, disease duration, dopamine agonist type and duration of DA usage and data of impulse control disorder were recorded. Patients were analyzed in two groups: ICD positive and ICD negative. Those with ICD positive are regrouped in themselves as having one type or multiple type ICD. Results: From a total of 328 patients using dopamine agonists, 157 (47,9%) were female and 171 (52,1%) were male. ICD was observed in 38 (11,8%) patients. Of them 11 were women and 26 were man. When patients with one ICD and more than one ICD were compared, younger patients are found to have more than one ICD (p=0.010). ICD frequency was higher in men. When ICD types were analyzed, excessive spending/shopping (%38), hypersexuality (%24), excessive eating (%18.4), punding and hobbism (%9), excessive gambling (%7), spending excessive time online (%4) and excessive wandering (%4) were observed. Hypersexuality was the more commonly and frequently seen ICD in men than women (F:M ratio=1:13). Conclusion: In this study, we found that ICD is seen in 10% of PD patients using dopamine agonist. ICD development risk is higher in the male gender. Younger patients are found to have a higher risk of multiple ICDs. Further multicentered prospective studies are needed to assess risk factors for ICD development.

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