A 79-year-old woman with Parkinson's disease is on Rotigotine patch; At a review she develops new impulse-control behaviours. What is the most suitable recommended action?

• A. Immediately stop Rotigotine
• B. Continue current dose and monitor
• C. Gradually reduce the Rotigotine dose
• D. Switch to a different dopamine agonist

Answer: (C)

Impulse-control behaviours during dopamine agonist therapy arise from overstimulation of mesolimbic pathways by the drug. Rotigotine delivers continuous dopaminergic stimulation, and when these behaviours appear, reducing the dopaminergic dose is the most effective first-step approach. Gradually tapering the Rotigotine dose lowers the abnormal drive that fuels the impulsive actions while still aiming to preserve enough dopamine activity to manage Parkinsonian symptoms. An abrupt stop could lead to withdrawal or a sudden worsening of motor symptoms, and simply continuing the same dose won’t address the behavioural issue. Switching to another dopamine agonist might still provoke similar problems if the overall dopaminergic stimulation remains high, so dose reduction is the best initial management and should be followed by close monitoring of both motor function and impulse-control symptoms.