One of the most dangerous of the impulse control disorders is what’s called sudden sleepiness or “sleep attacks.” It’s a major side effect of all the agonists and can have serious consequences if they occur while driving.
Jim Morgan, a partner at Squire Patton Boggs, a global law firm who was diagnosed with Parkinson’s about six years ago, remembers “periods of incredible drowsiness that can come on pretty suddenly. It’s hard to describe, but real fogginess. I could be in the car driving, only to wake up to find myself changing lanes. Mirapex was the worst for drowsiness; I’ve met several people who totaled their cars with it. It’s scary — you almost can’t fight it when it kicks in.”
Paul Schroder, who had early onset Parkinson’s that was diagnosed almost 15 years ago, once gambled away $30,000 at a casino. “It happened when I was 40 and new to the drugs. I wish I had known about the possibility that a gambling addiction could happen,” he says. “I never heard anything about it. I couldn’t drag myself away from it. It’s one of the natural consequences of dopamine — it increases the desire for pleasure centers to be stimulated.”
For a while, he went off Mirapex, but now that he’s living at home with his parents, with no access to casinos, he’s back on a generic form of the drug. He has a better handle on what’s happening, he says, and has more control of the outcome.
Not as much was known about ICDs when Schroder was in the throes of gambling addiction. Now, says Dr. Weintraub, you would definitely screen “for possible risk factors: younger age [A Parkinson’s diagnosis for someone 21 to 40 years old is considered “young” or early onset Parkinson’s] , gender differences, family and personal history.”
Or as Christopher Hess, assistant professor of Neurology at the University of Florida Center for Movement Disorders and Neurorestoration says, “A single guy with a history of impulsivity is a less likely candidate for dopamine agonists.” If this type of screening had been in place when Schroder was first diagnosed—a single, younger man with a predilection for gambling—he might have saved thousands of dollars.