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Medications for Restless Legs Syndrome may Trigger Compulsive Gambling

ible 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 a
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