Title: A Case of Compulsive Behaviors Observed in a Restless Legs Syndrome Patient Treated with a Dopamine Agonist
Abstract: DOPAMINE AGONISTS, ROPINIROLE AND PRAMIPEXOLE, ARE THE ONLY FDA-APPROVED RESTLESS LEGS SYNDROME (RLS) THERAPIES. AS SUCH, THESE TWO dopamine agonists are considered the first line of treatment (generally at low doses) for RLS in current evidenced-based guidelines.1 Dopamine agonists have long been used at higher doses to treat Parkinson disease (PD), and compulsive behaviors are well known to be associated with dopamine agonist use at these levels.2 In a small number of case reports, however, gambling has been observed in individuals with RLS who were treated on a low dose of dopamine agonists.3–5 In addition, Ondo and Lai6 reported that of 89 RLS patients treated with dopamine agonists, 7 manifested compulsive shopping behaviors and 2 manifested gambling, though none were reported to manifest the compulsive eating reported in some PD cases. The authors noted that a failure to identify similar compulsive behavioral patterns among RLS and PD patients likely related more to the higher dopamine agonist treatment range in PD rather than to specific neurobiological etiologies underlying the two disorders. Thus, Ondo and Lai speculated that the potential for RLS patients to develop compulsive behaviors may be less noticeable given the smaller doses of dopamine agonists used to treat those patients.6