The introduction of dopamine agonists was a welcome development in the treatment of Parkinson’s disease. However, their history has been somewhat checkered with concerns about their side effects including sudden onset of sleep and ‘sleep attacks’ the development of fibrotic side effects with ergot-derived agents; and most recently, the emergence of impulse control disorders. Furthermore, those who develop these behaviors are those most likely to suffer distressing side effects on their withdrawal: the so-called ‘dopamine agonist withdrawal syndrome’ (DAWS). This review examines this complex area and some suggested strategies to avoid and manage these phenomena, and concludes with some discussion of the future agenda for improving the understanding and management of these conditions.
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