Clinical note
Adverse effect of dopamine agonist therapy in a patient with motor-intentional neglect,☆☆,

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Abstract

Studies in animals and humans report dopamine agonists can improve neglect. Because dopamine deficit reduces intention to act, it has been suspected the dopamine agonist bromocriptine would improve deficient hemispatial intention. Thus, the effect of bromocriptine on line bisection was examined in a patient with neglect and failure of the action-intention system. The 58-year-old patient had left-sided neglect from a right cerebral infarction involving both cortical and subcortical (striatal) structures. It was determined that neglect on a line bisection task was attributable to a motor-intentional bias by testing under congruous and incongruous video monitoring. Testing sessions were held before starting bromocriptine, on 20mg/d, and after stopping bromocriptine. The patient's ipsilesional bias increased on bromocriptine, and improved when bromocriptine was stopped. Bromocriptine may worsen neglect if putamenal receptors are damaged. Dopamine agonists may activate the normal hemisphere, increasing an intentional bias. Clinicians using dopaminergic pharmacotherapy should assess patients for this possible adverse effect.

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Supported by Department of Veterans Affairs Merit Review grant 114-30-4813.

☆☆

Presented at the 49th annual meeting of the American Academy of Neurology, April 17, 1997, Boston, MA, and published in abstract form in Neurology 1997; 48: A374.

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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