1285 A First Case of Compulsive Amnestic Nocturnal Sleep-Related Shopping Induced by Pramipexole Therapy of Restless Leg Syndrome

Abstract Introduction Dopamine agonists such as pramipexole/ropinirole are treatments for restless legs syndrome (RLS) and Parkinson’s disease. It is well established that these medications can cause impulse control disorders (ICDs), side effects with serious and potentially life-altering consequences. ICDs are recurrent difficult to resist behaviors that can be harmful to the patient or others around them. Common examples include pathologic gambling, sexual behaviors, eating, and shopping. We present a patient with RLS who developed pathologic nocturnal sleep related shopping, without recall of the events, which resolved after stopping pramipexole. Report of case(s) A 58-year-old woman presented with a 28-year history of RLS, for which she was initially prescribed pramipexole. She denied a prior history of parasomnias or compulsive behaviors. After starting pramipexole, she reported episodes of pathologic nocturnal shopping, without recollection of the events. For example, she would awaken each morning to discover orders placed online for various items, but did not remember doing so. Unnecessary items such as kitchen knives, T-shirts, and vacuum parts would later arrive at her home. These items were also ordered in exceptionally high quantities, such as 60 kitchen knives. The time-stamped purchases took place on average 1 hour after sleep onset. During the daytime she took protective and compensatory measures such as removing credit cards from common retail websites and returning items. However, during each event she navigated around the safeguards placed, such as purchasing personalized items that could not be returned. She reported feeling ashamed of what was happening but was too embarrassed to discuss this with her doctor. Eventually, the nocturnal shopping caused strain on her marriage and drove her into debt. After hearing stories of impulsive behavior from other patients on pramipexole, she disclosed her symptoms to her doctor. After switching from pramipexole to ropinirole, her nocturnal shopping behavior ended. Conclusion This is the first case of pramipexole induced sleep-related ICD, with severe negative impact. The symptomatology can be so unusual that patients might be reluctant to discuss with their prescribing doctor. When prescribing dopamine agonists, providers should counsel patients on the symptoms of ICD, including manifestations during wakefulness and sleep. Support (if any)