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Thursday, February 08, 2007

Therapy for Restless Legs May Trigger Compulsive Gambling

A class of drugs commonly used to treat the neurological disorder restless legssyndrome (RLS) may cause compulsive gambling, researchers say.

Compulsive gambling with extreme losses -- in two cases, greater than $100,000 -- has been tied to the treatment, according to a Mayo Clinic study.

The Mayo Clinic study is the first to describe compulsive gambling in RLS patients who are being treated with medications that stimulate dopamine receptors in the brain. The Mayo Clinic report appeared in the Jan. 23 issue of Neurology.

The extent of this therapy-related compulsive gambling problem is unknown, the researchers say. Apparently, it occurs only in a small number of RLS patients treated with drugs called dopamine agonists. Considering this potential side effect of dopamine agonists, the Mayo Clinic authors suggest that physicians screen all RLS patients for compulsive behaviors while taking a thorough medical history prior to prescribing dopamine agonists. Patients should be monitored closely forsigns of compulsive behaviors once dopamine agonist treatment has begun. The report suggests that the compulsion to gamble worsened with increasing doses of the dopamine agonists.

Pathological gambling is an impulse control disorder. In 2005, Mayo Clinic physicians reported this disorder as a side effect of dopamine agonist therapy in 11 Parkinson disease patients.

"Although pathologic gambling has already been recognized in patients with Parkinson disease who often took high doses of dopamine agonists, the current report suggests that pathological gambling is not restricted to patients with Parkinson disease -- and also can occur at low dosages," says Maja Tippmann-Peikert, M.D., the lead author of the Mayo Clinic report on restless legs syndrome. "Physicians should not only monitor Parkinson disease patients for this behavior but also screen their RLS patients who may be on much lower doses of dopamine agonists."

This includes encouraging the patient, family members and friends to report negative behaviors to the patient's physician, the researchers say.

Fortunately, pathological gambling seems to be reversible when the dose of the dopamine agonist is reduced or the patient is transitioned to an alternative medication, they say. It is crucial that these adjustments are initiated before significant gambling debts develop, and relationships and careers are damaged, they add.

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