Impulse control disorders (ICDs) are a set of behaviours that take place in a subgroup of patients with Parkinson's disease (PD). Although reduction or switch of dopamine agonists or decrease of levodopa are the common treatment, this does not always improve the compulsive behaviour. Zonisamide (ZNS) has proved effective for motor symptoms in PD and it may be also useful in the field of ICDs. The aim of our study is to evaluate the safety and efficacy of ZNS in PD patients with ICDs who did not improve following a reduction of either levodopa or dopamine agonists. Fifteen patients were initiated on 25 mg/day ZNS dosage, which was titrated to 200 mg/day, as tolerated. Severity of the behaviours was assessed by means of the Clinical Global Impression and the Barratt Impulsiveness Scale, while motor impairment was assessed by means of the Unified Parkinson's Disease Rating Scale (UPDRS). Demographic data, medication dose, treatment duration and adverse events were also collected and analyzed. There was a marked reduction in the severity of impulsive behaviours and global impulsiveness (mean change from baseline -5.8 to -4.8, respectively). UPDRS changed only marginally. ZNS was generally well tolerated. Our study suggests that ZNS may be effective for ICDs in PD. The lack of studies with other medications to treat these behaviours in PD and the potential beneficial effects of ZNS for motor complications make this drug important in the treatment of the disease.

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SUMMARY Chorea is a rare manifestation of systemic lupus erythematosus (SLE). In this report the clinical features of two cases of chorea associated with SLE are presented. Of special interest were the raised titres of antiphospholipid antibodies in both cases. The possible pathogenic role of these antibodies is briefly discussed.

Although zonisamide was previously only used to treat epilepsy, recently more applications have been forthcoming. Due to a good side effect profile, a lower frequency of interactions and a more comfortable posology, there are several studies regarding its uses in other pathologies such as migraine, neuropathic pain, essential tremor and various psychiatric diseases. A multicentered, randomized, double-blind, placebo-controlled study conducted in Japan suggested that zonisamide, as an add-on treatment, has efficacy in treating motor symptoms in patients with Parkinson's disease. In addition, other studies support the utility of zonisamide in other symptoms of this disease. The therapeutic doses of zonisamide for the treatment of Parkinson's disease are considerably lower than those for the treatment of epilepsy. This antiepileptic drug has been used in Japan for more than 15 years and so it is expected that it will be safe and well tolerated in patients with Parkinson's disease. However, the pharmacological mechanisms of the antiparkinsonian actions of zonisamide remain unclear and more basic investigation is warranted. The aim of this paper is to review the structure, mechanisms of action, pharmacokinetics and antiparkinsonian action of zonisamide.