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Identification and Management of Impulse Control Disorders Among Individuals with Parkinson’s Disease

Identification and Management of Impulse Control Disorders Among Individuals with Parkinson’s Disease

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2
Teaser: 


Andrew M. Johnson, PhD, Associate Professor, School of Health Studies, Faculty of Health Sciences, The University of Western Ontario,
London, ON.
H. Christopher Hyson, MD, FRCPC, Assistant Professor of Neurology, Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON.
Kaitlyn P. Roland, MSc, Research Assistant, Interdisciplinary Graduate Studies, The University of British Columbia Okanagan, Kelowna, BC.

Abstract
Although Parkinson’s disease is primarily considered to be a motor disorder, it has inarguable effects on cognition and personality. The cluster of neuropsychiatric sequelae known as impulse-control disorders has been of particular interest in recent years, perhaps owing to the potentially disastrous effects that such behaviors can have on individuals and families. Research has suggested that impulse control disorders are significantly more prevalent among individuals with Parkinson’s disease, particularly with regards to pathological gambling and hypersexuality, and has further suggested that these disorders are significantly and substantively affected by the use of dopamine agonists. Treatment options for impulse control disorders tend to revolve around dopamine agonist dose reduction or cessation. The use of psychosocial strategies, or deep-brain stimulation of the subthalamic nucleus may also be considered in the management of patients with impulse control disorders.
Keywords: Impulse control disorders, Parkinson’s disease, dopamine agonists service use
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A Review of The Restless Legs Syndrome

A Review of The Restless Legs Syndrome

Teaser: 

Guillermo Paradiso, MD and Robert Chen, MBBChir, MSc, FRCPC, Division of Neurology and Krembil Neuroscience Centre, Toronto Western Research Institute, University Health Network; University of Toronto, Toronto, ON.

Restless legs syndrome (RLS) is a common disorder and its prevalence in the elderly is about 10%. It is characterised by unpleasant, difficult-to-describe sensations in the lower limbs and an irresistible desire to move the legs. The symptoms typically worsen in the evening and at night and often result in sleep disturbance. Idiopathic RLS is often familial. Secondary RLS may occur in several medical conditions, such as uremia and iron deficiency. Most patients with RLS also have periodic limb movements in sleep (PLMS), characterised by repetitive flexion of the lower extremities. RLS and PLMS may be the result of a dopaminergic dysfunction and PLMS may be due to release of spinal flexor reflex pathways. Dopaminergic agents, benzodiazepine and opioids are effective in treating RLS.
Key words: restless legs, periodic leg movement, sleep disorder, dopamine.