The Identification and Challenges of Dopamine Dysregulation Syndrome: A Case Report

TL;DR

A man with Parkinson's disease and opioid use disorder exhibited signs of dopamine dysregulation syndrome, highlighting the challenges in managing this condition.

Contribution

This case report provides insight into the clinical presentation and management challenges of dopamine dysregulation syndrome in a complex patient.

Findings

The patient showed compulsive overuse of carbidopa/levodopa, consistent with dopamine dysregulation syndrome.

Despite increased medication frequency, the patient's symptoms persisted, leading to non-compliance and hospital discharge against medical advice.

The case emphasizes the need for integrated treatment of Parkinson's disease and substance use disorders in managing dopamine dysregulation syndrome.

Abstract

A 48-year-old man with a history of opioid use disorder (unmanaged) and presumed Parkinson's disease presented to the emergency department secondary to worsening of his Parkinson's tremors/ambulatory dysfunction. He expressed that he was taking up to 20 doses of his carbidopa/levodopa (25mg-250mg pills for a total of >5g levodopa every day). The patient was admitted for the management of Parkinson’s tremors and substance abuse. He was administered carbidopa/levodopa (25mg-250mg) every eight hours. Psychiatry was consulted due to marked functional fluctuations in his presentation and found that he demonstrated positive choreiform movements of the head/neck and upper extremity after taking the carbidopa. The patient's presentation prompted a suspicion of dopamine dysregulation syndrome (DDS). Supporting evidence included that the patient was insistent that the current regimen of carbidopa/levodopa wasn’t managing symptoms, and even when the frequency was increased to every six hours, the patient expressed that his symptoms were still present and problematic. The patient stated that if the carbidopa/levodopa dosage wasn’t further increased, he would leave the hospital. He ended up leaving against medical advice and was later ultimately re-admitted with the goal of transitioning to a rehabilitation facility for the treatment optimization of his substance use disorder and Parkinson's disease.

This case demonstrates the challenges and presentation of DDS. DDS is a disorder marked by compulsive overuse of dopaminergic medication, which frequently occurs in individuals with Parkinson's disease. Additionally, this case reviews diagnostic criteria and moreover summarizes literature supporting methods of clinical management.