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Editorial |

Daytime Sleepiness, Agonist Therapy, and Driving in Parkinson Disease

Cynthia L. Comella, MD
JAMA. 2002;287(4):509-511. doi:10.1001/jama.287.4.509.
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Frucht and colleagues1 proposed the unique association between treatment of Parkinson disease (PD) with 2 newer dopamine agonists and the occurrence of sudden onset of sleep, or sleep attacks. They described a series of 8 patients with PD treated with pramipexole or ropinirole who were involved in motor vehicle collisions because they fell asleep at the wheel. This small case series prompted grave concerns about the safety of prescribing the non-ergot dopamine agonists to patients with PD who drive. Recommended prescribing practices in many countries were altered.2,3 Multiple anecdotal and retrospective reports followed, all linking agonist therapy with excessive daytime sleepiness and sudden onset of sleep in patients with PD.47 Yet these reports did not systematically assess the frequency of daytime sleepiness in patients treated with other medications. This was a serious omission. Although levodopa initially was observed to cause transitory sleeplessness8, within 5 years somnolence was also reported as an adverse effect.9,10 For example, in one series of 131 patients with PD treated with levodopa monotherapy, treatment was limited in 14% due to somnolence.11

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