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What do these things have in common? Well, everything! They are the heart and soul of what makes us thrive as human beings!

Long before I became I neurologist and Parkinson’s specialist & patient, I was a neurobiology major studying the basis of behavior learning the dopamine structures and pathways. I remember vividly having a discussion, thinking out loud if the chemicals of our brains, in our brains particularly things like dopamine REALLY DID defined us as individuals …giving us our unique personalities and abilities?

Dopamine that magnificent chemical which permeates our brains deep in the basal ganglia controlling everything from precision of movement, to deep feelings of love and everything in between. No wonder dopamine, art and chocolate all play such a vital role in most of our life’s. One author referred to “art  like chocolate for the brain.” This may be spot on since the mere thought of chocolate causes our brains to start producing dopamine.   I feel like I have come full circle… now a Parkinson’s patient …I have become a chocoholic and most definitely have experienced a profound change in personality much to my chagrin! However, a little dopamine and chocolate go a long way to restore my natural perky, adventures self back…maybe why I crave that wonderful substance so much?  Perhaps the Mayans were unto something after all when they named cacao the drink of the “god’s”-it is pure ecstasy, heaven on earth! Dopamine is the feel good chemical of the brain and if it mimics this well there you have it same as taking cocaine…same effect ( except without all the addiction and lethal side effects!)

This may explain why as our Parkinson’s advances a lot of us have a tendency to have an increase in craving for sweets particularly chocolate. But, there must be more to the story since scientist have attempted to find treatment for Parkinson’s using chocolate. The reason behind this is that the mere thinking of eating chocolate and of course consumption of chocolate releases quantities of endogenous dopamine according to research at the Georgia health science university. Intake of chocolate can give us an immediate quick ” fix.” It is no wonder that I and my grandmother and my close friend seem to gravitate towards chocolate as the demands on our body for dopamine increases and as the medications wear off especially when under stress and consumption of dopamine is at an all time high in our systems. Thus,  I firmly believe that some of that so called ” binging” phenomena seen with dopamine medication intake is due to fluctuations in blood stream and brain levels of dopamine …if we were able to maintain steady states the binging would diminish …as I have personally noticed in myself that when I am not as busy to forget to take medicines on time I don’t have the need to take or scrunch for ” chocolaty” treats. This may be an indication for us all to be more vigilant of our medication intake schedules and if we are reaching for supplement to increase the endogenous/ intrinsic production this could be a sign of fluctuations in a non motor system just like having a DYSKENESIAs or dystonia in the motor system.

Furthermore, chocolate has shown to release yet another chemical known as serotonin which is also believed to be involved in patients with Parkinson’s and dysfunction is what leads to depression especially in woman. Serotonin as many of you know is the compound or chemical used to treat depression, this again maybe a physiologic reason why women tend to reach for chocolate as comfort food more than men since it provides a natural antidepressant affect. So, both art and chocolate gives us a sense of pleasure and satisfaction by releasing natural dopamine chemicals in our brains. And as I described at the beginning dopamine is what makes us who we are as individuals by being more prone to be in love more easily than others, pursue pleasures more often than some and even have more developed reward driven centers than others. So, yes, those pesky chemicals in our brain like dopamine can wreak havoc in our world if not balanced throwing our established personalities for a loop making us behave in opposite ways than we once were. This can occur rather frequently after replacement begins by tipping scales over in excess of dopamine and lowering other chemicals in brain like serotonin which were once in perfect harmony. These chemicals REALLY do define us as human beings but more importantly as individuals with certain traits and characteristics that is why some of us are more driven than others, more likely to seek immediate gratification while others not so much. They determine our compulsions and our thrill seeking behavior. Some of us love the rush of adrenaline (use for dopamine precursor of adrenaline) so we look for jobs or hobbies that make us feel good by always having us on the border of excitement.

Although, there have been suggestions of a PD “personality type” (I will not go into detail about all the literature at this time) I truly believe that the “personality type” that is typically described that of rigid, socially awkward, depressive, overly controlling, morally rigid and stoic goes against every person whom I have ever known to have PD young and old, including myself, my grandmother and my best friend. Each one of us had opposite traits than those described in the literature prior to disease. I firmly believe that is the lack of dopamine or rather decline which causes these characteristic behaviors to begin to take place. All 3 of us became extremely depressed and despondent at the very early signs of disease even long before any motor symptoms were present. In talking to many groups during my advocacy work, I have found this to be the case as well for most of them. Since PD premorbid, or preclinical symptoms can present up to 10-15 years prior to motor symptoms occur what retroactive analysis of PD patients in regards to personality is encountering is the pre clinical state and not the normal phase of the individual. No studies have gone back to interview friends and family or coworkers of these patients further in the past while in school or at much younger ages. What this tells me is there is still much we don’t know and understand and endless possibilities for both clinical and scientific research to be done in this arena to attempt to clarify some of these very important questions. Therefore, when dopamine is reintroduced there may be a tendency to over correct and shift balance because we are disrupting normal brain homeostasis pushing dopamine in another direction…..Too much dopamine causing excessive behaviors that were once in check like punding (fascination with meaningless objects and activities), over eating (overindulgence, binge eating) increase in thrill seeking behaviors like hyper sexuality ( having multiple partners, engaging in porn), gambling, impulse buying, reckless driving, hoarding. Perhaps, our minds and bodies are trying to compensate for time lost, feelings, emotions lost-.trying to find a way of making us feel alive again or regain a sense of the way we were but go too far in the other direction because we are not sure how long the feeling will last…like a drug addict trying to maintain a high for as long as possible.

 Interestingly, there seems to be a greater occurrence of these behaviors in Europe followed by the US, then Canada ( not found a basis for this yet but something to think about) The abnormal behaviors are described as “failures to resist or control impulse, drive, or temptation to perform an act that is harmful to a single person or multiple groups including self.” I tried to find a reason for this but was unable to. I suspect that it has to do with numbers of prescriptions and years of usage but I could not get into a back to retrieve information. Perhaps some of you could enlighten me. Both Mirapex and Requip were introduced in the states in the late 1990’s. And NEUPRO was introduced in early 2000’s but only briefly because later taken off market and only returned to market just within last 2 years or so. I know that this has been out in Europe and in Canada a lot longer but longest in Europe and at higher doses than used in the US. These aberrant behaviors are mostly associated with dopamine agonists especially Mirapex (pramipexole), & Requip ( ropinirole) to a less extent NEUPRO (rigotine). actually all behaviors except the sexual and gambling problems occur in women more often then in men. interestingly…I think it has to do with women’s emotional needs to control world and express themselves emotionally- the way female brains are wired different particularly due to certain hormones (cortisol, adrenaline, oxytocin) in  dealing with stress; although present in both men and women they vary in quantities while dealing with stress. So, if we can learn to understand the gender differences in coping with stress, and predisposition to certain types of behaviors and realize that these come on most often at end of dose when wearing off and with long term usage of meds perhaps we can begin to make a difference in quality of life and avoid embarrassing moments or going into debt because can’t control spending or jeopardize relationships due to hyper sexuality and perhaps due learn to use alternative treatments to release endogenous dopamine in conjunction like chocolate intake to maintain steady states.

Do not make any changes to your regimens without first discussions with your physicians or health care providers. This piece is intended to arouse stimulation and thought of possible mechanisms of action which could be leading to some of these behaviors and also explore some of the alternative treatments based on literature and basic science. Please feel free to make any comments, very interested to hear your thoughts especially about intake of chocolate and also about when meds were introduced in your countries of origin? Thank you.

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Dr. M. De Leon is a movement disorder specialist on sabbatical, PPAC member and research advocate for PDF (Parkinson’s Disease Foundation); Texas State Assistant Director for PAN (Parkinson’s Action Network). You can learn more about her work at http://www.facebook.com/defeatparkinsons101 you can also learn more about Parkinson’s disease at www.pdf.org or at www.wemove.org; http://www.aan.org, http://www.defeatparkinsons.blogspot.com

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