Abstract：
BACKGROUND: Impulse-control and related behavioral disorders (ICBDs) significantly impact the lives of Parkinson\'s disease (PD) patients and caregivers, with lasting consequences if undiagnosed and untreated. While ICBD pathophysiology and risk factors are well-studied, a standardized severity definition and treatment evidence remain elusive.
OBJECTIVE: This work aimed to establish international expert consensus on ICBD treatment strategies. To comprehensively address diverse treatment availabilities, experts from various continents were included.
METHODS: From 2021 to 2023, global movement disorders specialists engaged in a Delphi process. A core expert group initiated surveys, involving a larger panel in three iterations, leading to refined severity definitions and treatment pathways.
RESULTS: Experts achieved consensus on defining ICBD severity, emphasizing regular PD patient screenings for early detection. General treatment recommendations focused on continuous monitoring, collaboration with significant others, and seeking specialist advice for legal or financial challenges. For mild to severe ICBDs, gradual reduction in dopamine agonists was endorsed, followed by reductions in other PD medications. Second-line treatment strategies included diverse approaches like reversing the last medication change, cognitive behavior therapy, subthalamic nucleus deep brain stimulation, and specific medications like quetiapine, clozapine, and antidepressants. The panel reached consensus on distinct treatment pathways for punding and dopamine dysregulation syndrome, formulating therapy recommendations. Comprehensive discussions addressed management strategies for the exacerbation of either motor or non-motor symptoms following the proposed treatments.
CONCLUSIONS: The consensus offers in-depth insights into ICBD management, presenting clear severity criteria and expert consensus treatment recommendations. The study highlights the critical need for further research to enhance ICBD management. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
OBJECTIVE: This work aimed to establish international expert consensus on ICBD treatment strategies. To comprehensively address diverse treatment availabilities, experts from various continents were included.
METHODS: From 2021 to 2023, global movement disorders specialists engaged in a Delphi process. A core expert group initiated surveys, involving a larger panel in three iterations, leading to refined severity definitions and treatment pathways.
RESULTS: Experts achieved consensus on defining ICBD severity, emphasizing regular PD patient screenings for early detection. General treatment recommendations focused on continuous monitoring, collaboration with significant others, and seeking specialist advice for legal or financial challenges. For mild to severe ICBDs, gradual reduction in dopamine agonists was endorsed, followed by reductions in other PD medications. Second-line treatment strategies included diverse approaches like reversing the last medication change, cognitive behavior therapy, subthalamic nucleus deep brain stimulation, and specific medications like quetiapine, clozapine, and antidepressants. The panel reached consensus on distinct treatment pathways for punding and dopamine dysregulation syndrome, formulating therapy recommendations. Comprehensive discussions addressed management strategies for the exacerbation of either motor or non-motor symptoms following the proposed treatments.
CONCLUSIONS: The consensus offers in-depth insights into ICBD management, presenting clear severity criteria and expert consensus treatment recommendations. The study highlights the critical need for further research to enhance ICBD management. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
摘要：
背景：冲动控制和相关行为障碍（ICDs）显著影响帕金森病（PD）患者和护理人员的生活，如果未诊断和未治疗，后果将持续。虽然ICBD的病理生理学和危险因素得到了充分的研究，标准化的严重程度定义和治疗证据仍然难以捉摸.
目的：这项工作旨在就ICBD治疗策略建立国际专家共识。为了全面解决多样化的治疗可用性，包括来自各大洲的专家。
方法：从2021年到2023年，全球运动障碍专家从事Delphi过程。一个核心专家组发起了调查，在三个迭代中涉及一个更大的面板，导致细化的严重程度定义和治疗途径。
结果：专家就定义ICBD严重程度达成共识，强调定期进行PD患者筛查，以便早期发现。一般治疗建议侧重于持续监测，与重要的其他人合作，并就法律或财务挑战寻求专家意见。对于轻度至重度ICDs,逐渐减少多巴胺激动剂得到认可，其次是其他PD药物的减少。二线治疗策略包括多种方法，例如逆转上次的药物变化，认知行为疗法,丘脑底核深部脑刺激，和特定的药物如喹硫平，氯氮平,和抗抑郁药。小组就不同的治疗途径达成共识，以治疗punding和多巴胺失调综合征，制定治疗建议。全面的讨论讨论了在拟议的治疗后，运动或非运动症状恶化的管理策略。
结论：共识为ICBD管理提供了深入的见解，提出明确的严重程度标准和专家共识治疗建议。这项研究强调了进一步研究以加强ICBD管理的迫切需要。©2024作者由WileyPeriodicalsLLC代表国际帕金森症和运动障碍协会出版的运动障碍。
目的：这项工作旨在就ICBD治疗策略建立国际专家共识。为了全面解决多样化的治疗可用性，包括来自各大洲的专家。
方法：从2021年到2023年，全球运动障碍专家从事Delphi过程。一个核心专家组发起了调查，在三个迭代中涉及一个更大的面板，导致细化的严重程度定义和治疗途径。
结果：专家就定义ICBD严重程度达成共识，强调定期进行PD患者筛查，以便早期发现。一般治疗建议侧重于持续监测，与重要的其他人合作，并就法律或财务挑战寻求专家意见。对于轻度至重度ICDs,逐渐减少多巴胺激动剂得到认可，其次是其他PD药物的减少。二线治疗策略包括多种方法，例如逆转上次的药物变化，认知行为疗法,丘脑底核深部脑刺激，和特定的药物如喹硫平，氯氮平,和抗抑郁药。小组就不同的治疗途径达成共识，以治疗punding和多巴胺失调综合征，制定治疗建议。全面的讨论讨论了在拟议的治疗后，运动或非运动症状恶化的管理策略。
结论：共识为ICBD管理提供了深入的见解，提出明确的严重程度标准和专家共识治疗建议。这项研究强调了进一步研究以加强ICBD管理的迫切需要。©2024作者由WileyPeriodicalsLLC代表国际帕金森症和运动障碍协会出版的运动障碍。
