Medical Therapy For Restless Legs Syndrome May Trigger Compulsive Gambling

Science Daily — Compulsive gambling with extreme losses -- in two cases, greater than $100,000 -- by people without a prior history of gambling problems has been linked to a class of drugs commonly used to treat the neurological disorder restless legs syndrome (RLS). A new Mayo Clinic study is the first to describe this 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 problem is unknown. 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 for signs 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" explains 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.

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. It is crucial that these adjustments are initiated before significant gambling debts develop, and relationships and careers are damaged.

This preliminary Mayo Clinic report is the first to link pathologic gambling to use of dopamine agonists in a disease other than Parkinson. It is based on the experience of three patients who have RLS. Their gambling problems were discovered during their medical evaluations at the Mayo Clinic Sleep Disorders Center. Although three patients is a small sample and larger studies are needed to validate these observations, the Mayo Clinic authors believe that the possible link between dopamine agonists and pathologic gambling behavior should be brought to physicians' attention immediately due to the social and financial consequences resulting from the behavior.

The Mayo Clinic neurologists found that gambling problems began, on average, about nine months after the patients began taking one of two dopamine agonists, pramipexole or ropinirole. Speculation is that the gambling problems are emerging now because the newer generation of dopamine agonists -- including pramipexole and ropinirole -- are targeting receptors located in brain structures involved in motivation, emotion and reward behaviors. Researchers theorize that, in some people, such strong and specific stimulation in these neuronal pathways can prompt compulsive, pleasure-seeking behaviors such as pathological gambling.

One patient, a woman seen in the Mayo Clinic Sleep Disorders Center, had a five-year history of regular nighttime creeping-crawling sensations in her legs, accompanied by the strong urge to move her legs. Two and a half years prior to her Mayo Clinic visit, she had been diagnosed with RLS and treatment with pramipexole was begun.

Her symptoms improved, however, a problematic behavior developed soon after she started taking the medication. She developed an uncontrollable urge to gamble when visiting the nearby casino. As the dose increased, her gambling compulsion grew stronger. The transition of her therapy to another dopamine agonist, ropinirole, further increased her compulsion to gamble. Prior to her treatment for RLS, she had no history of gambling and viewed gamblers as "unfortunate individuals," the authors report. The patient lost more than $140,000 from gambling.

Mayo Clinic physicians discontinued the dopamine agonist therapy and her urge to gamble completely disappeared, but the troublesome leg sensations returned. Her RLS is now successfully treated with a non-dopamine agonist, gabapentin, and she has no side effects, according to the authors.

The Mayo Clinic team also included: John Park, M.D.; Bradley Boeve, M.D.; John Shepard, M.D.; and Michael Silber, M.B.Ch.B.

Wow, look for some ambulance chaser to file a class action suit tonight for these people.

4 posted on 02/09/2007 11:26:48 AM PST by Abathar (Proudly catching hell for posting without reading the article since 2004)

I guess they'll have to stop telling patients that the odds are 3:2 that the treatment works.

-PJ

6 posted on 02/09/2007 11:36:55 AM PST by Political Junkie Too (It's still not safe to vote Democrat.)

My goodness...if John Edwards were to withdraw from politics and focus on this he could soon afford a house that's 100,000 square feet rather than the little 25,000 sq ft shack he's now building in NC.

7 posted on 02/09/2007 11:36:59 AM PST by Gay State Conservative ("The meaning of peace is the absence of opposition to socialism."-Karl Marx)

I passed this on to my father as my mother suffers from RLS and also really enjoys bingo and the slots. Maybe she could be a case study for these researchers.

9 posted on 02/09/2007 11:43:57 AM PST by BureaucratusMaximus (Our national sovereignty and cohesion as a country is not for sale at any price.)

I believe that I have a very mild case of RLS (the symptoms are mildly annoying but nothing more)but am uncertain because I've never even bothered to mention it to my doctor.After seeing this I won't ever consider taking this medication because two of the biggest Indian casinos in the country are about a one hour drive from me.

10 posted on 02/09/2007 11:46:11 AM PST by Gay State Conservative ("The meaning of peace is the absence of opposition to socialism."-Karl Marx)

11 posted on 02/09/2007 2:40:47 PM PST by raybbr (You think it's bad now - wait till the anchor babies start to vote.)

Brain's reward circuit activity ebbs and flows with a woman's hormonal cycle
NIH via Eureka Alert | 2-Feb-2007 | Jules Asher
Posted on 02/03/2007 8:01:30 PM EST by Pharmboy
http://www.freerepublic.com/focus/f-chat/1778829/posts

12 posted on 02/14/2007 10:06:50 PM PST by SunkenCiv (I last updated my profile on Wednesday, February 14, 2007. https://secure.freerepublic.com/donate/)

So, here's the plan...

Go to your doctor, and fake the symptoms for RLS. Get yourself a prescription for pramipexole. FIll the prescription, but flush the pills down the toilet.

Then book a trip to Las Vegas and gamble like there is no tomorrow! If you win, laugh all the way to the bank. If you lose, file suit against your doctor, your pharmacist and the manufacturer of the drug in order to cover your losses!

It's a win-win!

13 posted on 02/15/2007 5:13:59 AM PST by bondjamesbond (Washington D.C. exists to prove the proposition that no amount of money will ever be enough money.)

14 posted on 02/15/2007 10:06:48 PM PST by GOPJ (Historically, the claim of consensus has been the first refuge of scoundrels...Crighton)

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