Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Behavioral Changes Associated with Dopamine Agonist Treatment in the Follow-up of Restless Legs Syndrome: A Retrospective Study
Huzursuz Bacaklar Sendromunda Dopamin Agonisti Tedavisi ile İlişkili Davranış Değişiklikleri: Retrospektif Bir Çalışma
Figen VARLIBAŞa, Gülbün YÜKSELb, Özkan AKHANc, Zeynep BAŞTUĞ GÜLd, Burçak ERGİNe
aProgram of Electroneurophysiology, University of Health Sciences Hamidiye Vocational School of Health Services, İstanbul, TURKEY
bClinic of Neurology, Haydarpaşa Numune Training and Research Hospital, İstanbul, TURKEY
cClinic of Neurology, Safranbolu State Hospital, Karabük, TURKEY
dClinic of Neurology, Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurological and Neurosurgical Diseases, İstanbul, TURKEY
eClinic of Neurology, Bandırma Training and Research Hospital, Balıkesir, TURKEY
Turkiye Klinikleri J Med Sci. 2021;41(4):438-44
doi: 10.5336/medsci.2021-84596
Article Language: EN
Full Text
ABSTRACT
 Objective: Restless legs syndrome (RLS) is a neurological sensorimotor disease. Behavioral changes are little-known concern during the treatment and follow-up of RLS. The aim of the study is to highlight the behavioral changes associated with dopamine agonist treatment in the follow-up of RLS, such as dopamine dysregulation syndrome (DDS) and impulse control disorder (ICD). Material and Methods: We analyzed clinical data from RLS patients' files from the previous 15 years retrospectively. The patients receiving dopaminergic monotherapy for RLS, who came to follow-up on a regular basis and whose last examination was within the last 6 months were chosen. The average age of patients without behavioral changes was 48.60±9.21 years. Results: Of the patients' complaints, legs were affected in 90.90%, arms and legs together were affected in 9.09%. Dopamine agonist-related changes were observed in 6 female patients. Mean age of these patients was 40.16±9.23 years old. They showed behavioral abnormalities such as uncontrolled drug use, shopping curiosity, hypersexuality, smoking, and space decoration. One patient presented with manic episode together with DDS. The average age of RLS patients who experienced behavioral changes was younger. Average dose at which behavior changes were observed was unclear since 4 of 6 patients with behavioral changes developed DDS. Despite using a regular-low dose agonist, the other two female patients showed ICD without DDS. Conclusion: With dopaminergic treatment, behavioral changes that may cause problems in family and social life can develop. When prescribing dopaminergic medications, it is important to ask if the patient has any behavioral changes and pay close attention in a busy polyclinic.

Keywords: Restless legs syndrome; dopamine dysregulation syndrome; impulse control disorder; punding; dopamine agonist
ÖZET
 Amaç: Huzursuz bacaklar sendromu (HBS) nörolojik bir sensörimotor hastalıktır. HBS'nin tedavi ve takibi sırasında ortaya çıkabilen davranış değişiklikleri yaygın değildir. Çalışmamızın amacı, HBS'nin takibinde dopamin agonisti tedavisi ile ilişkili dopamin disregülasyonu sendromu (DDS) ve dürtü kontrol bozukluğu (DKB) gibi davranış değişikliklerine dikkat çekmektir. Gereç ve Yöntemler: HBS tanısı olan hastaların dosya kayıtları geriye dönük olarak 15 yılı içine alacak şekilde incelendi. HBS için tek tip dopaminerjik tedavi kullanan, düzenli olarak kontrole gelen ve son kontrol muayenesi 6 ay içinde yapılmış olan hastalar seçildi. Davranış değişikliği olmayan hastaların ortalama yaşı 48,60±9,21 yıldı. Bulgular: Hastaların şikâyetlerinin %90,90'ı bacaklar, %9,09'u da kol ve bacaklar birlikte etkilenmiş olarak kaydedilmişti. Altı kadın hastada dopamin agonistleri ile ilişkili davranış değişiklikleri vardı. Bu hastaların ortalama yaşı 40,16±9,23 idi. Bu hastalar kontrol edemedikleri bağımlılık şeklinde yüksek doz ilaç kullanımı, aşırı alışveriş, cinsel yaşamda artış, kontrol edemedikleri sigara kullanımı, amaçsız ortam dekorasyonları şeklinde davranış değişiklikleri göstermişti. Bir hasta DDS ile beraber manik atağı tanısı almıştı. Davranış değişiklikleri yaşayan HBS hastalarının ortalama yaşı daha gençti. Davranış değişikliklerinin gözlendiği ortalama ilaç dozu, davranış değişiklikleri olan 6 hastanın 4'ünde DDS geliştiği için belirsizdi. Diğer 2 hasta düzenli-düşük doz bir agonist kullanmasına rağmen DKB gösterdi. Sonuç: Dopaminerjik tedavi ile aile ve sosyal yaşamda sorunlara neden olabilecek davranış değişikliklikleri gelişebilir. Dopaminerjik ilaçlar reçete edilirken, yoğun poliklinik şartlarında dikkatli olunmalı ve hastanın herhangi bir davranış değişikliği olup olmadığı iyi sorgulanmalıdır.

Anahtar Kelimeler: Huzursuz bacaklar sendromu; dopamin disregülasyonu sendromu; dürtü kontrol bozukluğu; punding; dopamin agonisti
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