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Post of the Week: Management of Punding and ICD's in Parkinson's disease

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#1 Dr. Okun

Dr. Okun

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Posted 14 November 2010 - 07:46 AM

Dear forum members,

Punding is a behavior that may occur in PD as a result of dopaminergic stimulation (a result of the treatment and the disease- levodopa/agonist). It is a repetitive behavior that develops in patients that they cannot control easily (taking apart a watch and putting it back together over and over for example....).

This group recently studied a few patients and found some strategies potentially useful including decreasing dopamine drugs, amantadine, and seroquel.

I will add that our own group has also used clozapine.

This is an area that needs more investigation!

The abstract is below:

J Neurol. 2010 Nov 12. [Epub ahead of print]
Management of punding in Parkinson's disease: an open-label prospective study.
Fasano A, Ricciardi L, Pettorruso M, Bentivoglio AR.

Istituto di Neurologia, Università Cattolica del Sacro Cuore Largo Agostino Gemelli, 8, 00168, Rome, Italy, alfonso.fasano@rm.unicatt.it.
Punding, a peculiar stereotyped behavior characterized by intense fascination with complex, excessive, non-goal-oriented, repetitive activities, is a quite rare condition complicating Parkinson's disease (PD). It is triggered by dopaminergic therapy and could have a strong impact on patient quality of life. No study has specifically investigated medical management of this condition, and only a few anecdotal reports have provided therapeutic hints. Given the suggested similarities to drug-induced dyskinesias, we have previously suggested a multistep algorithm for management of punding. We conducted a prospective open-label study on ten PD punders aimed at testing its validity. In two cases, reduction of levodopa therapy was efficacious; amantadine was effective in controlling punding in four cases; in the remaining cases, quetiapine was employed, with mild efficacy in two cases.

PMID: 21072531 [PubMed - as supplied by publisher]

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Michael S. Okun, M.D.

Author of Amazon Kindle, Paperback and Audio of 10 Breakthrough Therapies for Parkinson's Disease
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
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UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
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