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Dr. Okun

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

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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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