Exactly how big a risk is it to drive if you are taking a dopamine agonist for Parkinson's disease? A survey by the Canadian Movement Disorders Group recently set out to answer this question. Somnolence is a recognized adverse effect of dopamine agonists, and two new dopamine agonists, pramipexole and ropinirole, have been reported to cause sudden-onset sleep spells in PD patients while they were driving. The group conducted a prospective survey of 638 consecutive, highly functional PD patients without dementia, 420 of whom were currently drivers. They assessed the sleepiness of the patients using a modified version of the Epworth Sleepiness Scale and the Inappropriate Sleep Composite Score. They found that patients taking a variety of different dopamine agonists had no differences in Epworth sleepiness scores, in the composite score or in the risk of falling asleep while driving. They also found that excessive daytime sleepiness is common although sudden-onset sleep is infrequent. The Epworth score had adequate sensitivity for predicting prior episodes of falling asleep while driving and its specificity could be increased by use of the Inappropriate Sleep Composite Score.
The authors recommend that patients should be educated to recognize the warning symptoms and the associated risks of these episodes occurring while driving and about the importance of never driving when sleepy.
Source
- Hobson DE, Lang AE, Wayne Martin WR et al. Excessive daytime sleepiness and sudden-onset sleep in Parkinson Disease. A survey by the Canadian Movement Disorders Group. JAMA 2002;287:455-63.
