Reduction in Parkinson’s Disease Therapy Improved Punding But Not Feeling of Presence

Aquino, Camila C.; Castro, Pollyana Celso de; Doná, Flávia; Medeiros, Leonardo; Silva, Sônia Maria Cesar Azevedo; Borges, Vanderci; Ferraz, Henriques Ballalai

doi:10.1176/appi.neuropsych.12070173

Cited by 3 publications

(4 citation statements)

References 5 publications

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“…These dyskinesia predominantly consist of dystonia, or more rarely ballism, often involve the lower extremities, and are referred to as "diphasic dyskinesia" or "dystoniaimprovement-dystonia" (DID) [8]. Other rarer behaviors that have been described in relation to levodopa dosing include abnormal involuntary eye movements (often stereotyped upward or horizontal gaze deviations that can be jerky, tonic, or more sustained), disordered breathing, involuntary abdominal movements ("bellydancer's dyskinesia"), and compulsive handling, sorting, or arranging of objects ("punding") [9][10][11][12][13][14][15][16][17]. During OFF episodes, and especially during early morning akinesia, patients may develop painful dystonia, often involving the lower extremity with inversion and plantar flexion of the feet and toes, although dystonia of other body regions may occur as well.…”

Section: Introductionmentioning

confidence: 99%

Medical Management and Prevention of Motor Complications in Parkinson's Disease

Aradi

Hauser

2020

Neurotherapeutics

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Levodopa is the most effective medication for the treatment of the motor symptoms of Parkinson's disease. However, over time, the clinical response to levodopa becomes complicated by a reduction in the duration and reliability of motor improvement (motor fluctuations) and the emergence of involuntary movements (levodopa-induced dyskinesia). Strategies that have been attempted in an effort to delay the development of these motor complications include levodopa sparing and continuous dopaminergic therapy. Once motor complications occur, a wide array of medical treatments is available to maximize motor function through the day while limiting dyskinesia. Here, we review the clinical features, epidemiology, and risk factors for the development of motor complications, as well as strategies for their prevention and medical management.

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Section: Introductionmentioning

confidence: 99%

Medical Management and Prevention of Motor Complications in Parkinson's Disease

Aradi

Hauser

2020

Neurotherapeutics

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“…Most of these patients developed punding after the introduction or increase of DA and/or levodopa, or with surreptitious intake of levodopa. Treatment‐wise, the reduction or discontinuation of the DA and/or levodopa, the introduction of clozapine or IJL resulted in complete relief or improvement in seven patients (64%) 33–35,38–40 …”

Section: Resultsmentioning

confidence: 99%

“…Treatment‐wise, the reduction or discontinuation of the DA and/or levodopa, the introduction of clozapine or IJL resulted in complete relief or improvement in seven patients (64%). 33 , 34 , 35 , 38 , 39 , 40 …”

Section: Resultsmentioning

confidence: 99%

Punding in Parkinson's Disease: An Update

Rajalingam

Fasano

2023

Movement Disord Clin Pract

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Background Punding is a stereotyped behavior characterized by an intense fascination with a complex, excessive, non‐goal oriented, repetitive activity affecting individuals with Parkinson's disease (PD) on dopamine replacement therapy (DRT). Objectives In 2010, we published the first review focused on the pathophysiology of punding. This study aims to systematically review the literature of the past decade on punding in PD, particularly focusing on the clinical features, underlying pathophysiological mechanisms, and treatment. Methods Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, we searched PubMed, Embase, and APA PsycInfo for articles published between July 1, 2010 and March 19, 2022. The search strategy included: (punding) AND (parkinson*). Results Of 256 studies identified, 29 were eligible for inclusion with 19 original research articles and 10 case reports. This review confirmed that predictors of punding in PD are higher doses of DRT, younger age, male sex, and increasing disease severity. We also found an association between punding and psychiatric and/or cognitive symptoms. Neuroimaging studies have showed that punding in PD is associated with a disconnection between midbrain, limbic and white matter tracts projecting to the frontal cortices and a breakdown of the connectivity among the crucial nodes of the reward circuit. Low‐frequency repetitive transcranial magnetic stimulation on the dorsolateral prefrontal cortex has been shown to produce a transient beneficial effect in PD patients with punding. Conclusion In conclusion, although the clinical features of punding have been established, in the past 12 years, we gained a better understanding of the pathophysiological mechanisms of punding, mainly thanks to magnetic resonance imaging techniques.

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“…Symptoms of punding improved strikingly after reduction or cease of levodopa or DAs (Fernandez and Friedman, 1999 ; Kumar, 2005 ; Miwa and Kondo, 2008 ). However, caution is required to get a careful balance between the control of side effects and deterioration of motor symptoms (Aquino et al, 2013 ). Entacapone could be adopted in case of worsened motor condition (Evans et al, 2004 ).…”

Section: Pundingmentioning

confidence: 99%

Impulsive and Compulsive Behaviors in Parkinsonâ€™s Disease

Zhang

Liu

et al. 2014

Front. Aging Neurosci.

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Background: Impulsive and compulsive behaviors (ICBs) are a heterogeneous group of conditions that may be caused by long-term dopaminergic replacement therapy (DRT) of Parkinson’s disease (PD). The spectrum of ICBs includes dopamine dysregulation syndrome (DDS), punding, and impulse control disorders (ICDs).Contents: We made a detailed review regarding the epidemiology, pathology, clinical characteristics, risk factors, diagnosis as well as treatment of ICBs.Results: The prevalence of ICBs in PD patients is approximately 3–4% for DDS, 0.34–4.2% for punding, and 6–14% for ICDs, with higher prevalence in Western populations than in Asian. Those who take high dose of levodopa are more prone to have DDS, whereas, ICDs are markedly associated with dopamine agonists. Different subtypes of ICBs share many risk factors such as male gender, higher levodopa equivalent daily dose, younger age at PD onset, history of alcoholism, impulsive, or novelty-seeking personality. The Questionnaire for Impulsive–Compulsive Disorder in Parkinson’s Disease-Rating Scale seems to be a rather efficacious instrument to obtain relevant information from patients and caregivers. Treatment of ICBs is still a great challenge for clinicians. Readjustment of DRT remains the primary method. Atypical antipsychotics, antidepressants, amantadine, and psychosocial interventions are also prescribed in controlling episodes of psychosis caused by compulsive DRT, but attention should be drawn to balance ICBs symptoms and motor disorders. Moreover, deep brain stimulation of the subthalamic nucleus might be a potential method in controlling ICBs.Conclusion: The exact pathophysiological mechanisms of ICBs in PD remains poorly understood. Further researches are needed not only to study the pathogenesis, prevalence, features, and risk factors of ICBs, but to find efficacious therapy for patients with these devastating consequences.

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Reduction in Parkinson’s Disease Therapy Improved Punding But Not Feeling of Presence

Cited by 3 publications

References 5 publications

Medical Management and Prevention of Motor Complications in Parkinson's Disease

Medical Management and Prevention of Motor Complications in Parkinson's Disease

Punding in Parkinson's Disease: An Update

Impulsive and Compulsive Behaviors in Parkinsonâ€™s Disease

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