Punding on L-dopa

Abstract

"Punding" is a stereotypical motor behavior in which there is an intense fascination with repetitive handling and examining of mechanical objects, such as picking at oneself or taking apart watches and radios or sorting and arranging of common objects, such as lining up pebbles, rocks, or other small objects. It is thought to be dopamine-related although only a single report of punding in a patient with Parkinson's disease (PD) resulting from L-dopa has been reported. We describe three additional cases. All were women aged 65-72 years with a PD duration between 10 and 20 years, on 500-1900 mg L-dopa per day. One spent hours in the market fascinated by cans. At home she endlessly examined and catalogued her jewelry. Another picked threads in rugs indoors and weeded her garden compulsively to the point of wetting herself rather than stopping. The third hoarded flashlights taking them apart and reassembling them. All improved with reduction of their anti-PD medications. We think punding is an uncommon but overlooked complication of dopaminergic drugs.