Know the characteristics, epidemiology, treatment, diagnosis of drug induced parkinsonism. Also know which drugs can cause parkinsonism and how to differentiate between drug induced parkinsonism and parkinsonism disease. Nonneuroleptic drugs and drug induced parkinsonism the commonly used antiemetics prochlorperazine and metoclopramide are an important cause of drug induced parkinson ism,6 a fact often not realised by primary care clinicians and even neurologists. Dip is more common in older patients, as are neurodegenerative. Common symptoms include problems with memory, sleep, mood and movement. Other risk factors include a family history of parkinson s and affective disorders. Druginduced parkinsonism dip is the second most common cause of parkinsonism in the general population after parkinsons disease pd but a range of rarer aetiologies, some of them reversible, should also be considered in patients of all ages. Symptoms typically manifest within a few days, and 90% of cases emerge within 3 months. Druginduced parkinsonism dip has been known for 60 years. This dopamine deficiency leads to the characteristic combination.
In 1817, james parkinson described the shaking palsy now known as parkinson disease pd. This specific druginduced parkinsonism dip mimics idiopathic parkinsons disease with the typical parkinsonian triad but the symptomatology of this disorder is a rather akinetic rigid syndrome with lesser incidence of resting tremor. There are reports of calcium channel blockers such as diltiazem and verapamil causing drug induced parkinsonism on rare occasions. Druginduced parkinsonism associated with dysphagia and. Any patient presenting to outpatient department with symptoms suggestive of parkinsonism syndrome should undergo detailed history about medication taken during past year. Dip may develop in individuals treated with dopamine receptorblocking agents, such as neuroleptics and antiemetics, dopamine depleters, and calcium channel blockers 3. We report a case of a 74yearold woman, without prior symptoms of parkinsonism or dysphagia, who presented with the temporal association of both after administration of trifluoperazine hydrochloride. Know the characteristics, epidemiology, treatment, diagnosis of druginduced parkinsonism. Druginduced parkinsonism dip is commonly seen in movement disorder clinics 1, 2. Doctors call this condition druginduced parkinsonism. One or more of the cardinal features of tremor, rigidity or bradykinesia. Drug induced parkinsonism is a condition that includes the presence of resting tremor, muscular rigidity, akinesia, or bradykinesia, developing within few weeks after starting or raising the.
Drug induced parkinsonism some drugs can cause parkinsonism. Druginduced parkinsonism in older adults introduction the development of the atypical antipsychotic drugs is mistakenly believed by many physicians to have put an end to druginduced movement disorders. Parkinsonism is defined by the presence of the cardinal symptoms of bradykinesia, rigidity, tremor, and postural instability. It is the second leading cause of parkinsonism, but still. However, like anticholinergic drugs, amantadine may also cause confusion, and sometimes psychosis in older people, and therefore is more suitable for younger people with drug induced parkinsonism. Druginduced movement disorders mental health clinician. Examples of drugs that could cause it include aripiprazole abilify, haloperidol haldol, and metoclopramide reglan. Druginduced dysphagia the first reported case of druginduced dysphagia occurred in 1970.
Dopamine transporter imaging has high accuracy in differentiating between dip and pd. Dysphagia as a complication of the drugs therapeutic action. Pdf druginduced parkinsonism marina anikina academia. Druginduced parkinsonism dip is the second most common cause of parkinsonism after parkinsons disease. Druginduced parkinsonism parkinsons disease research.
Persistent druginduced parkinsonism in patients with normal. The use of neuroleptics as psychotherapeutic agents has resulted in extrapyramidal syndromes including parkinsonism. Druginduced parkinsonism is the most common secondary cause, followed by vascular parkinsonism arteriosclerotic pseudoparkinsonism which generally affects the lower body and involves gait disturbance and cognitive impairment. Many patients with dip may be misdiagnosed with pd because the clinical features of these two conditions are indistinguishable. Drug induced parkinsonism dip is commonly seen in movement disorder clinics 1, 2. View the article pdf and any associated supplements and figures.
Other risk factors include a family history of parkinsons and affective disorders. Pdf on sep 1, 2016, pierre blanchet and others published druginduced parkinsonism. Drug induced parkinsonism dip is the second most common cause of parkinsonism after parkinsons disease. Idiopathic parkinson s disease ipd vs drug induced parkinsonism over the time biggest challenge encountered in dip is to differentiate it from ipd. Druginduced parkinsonism dip has been recognized as the second most common form of parkinson ism after idiopathic parkinsons disease 2. Dysphagia as a complication of the drug s therapeutic action. Drug induced parkinsonism adversely affects the quality of life in older patients and is potentially reversible, highlighting the importance of early recognition of this condition. The form of parkinsonism that develops after being treated with particular medications is known as druginduced parkinsonism. Treatment for one may worsen the other, and there are important diagnostic clues that assist in making an accurate assessment and instituting. Many patients with dip may be misdiagnosed with parkinson s disease pd because the clinical feature of. Druginduced parkinsonism is a condition that includes the presence of resting tremor, muscular rigidity, akinesia, or bradykinesia, developing within few weeks after starting or raising the. Diagnosis and differential diagnosis of parkinsons disease and parkinsonism. Druginduced parkinsonism dip is the secondmostcommon etiology of parkinsonism in the elderly after parkinsons disease pd.
Druginduced parkinsonism versus idiopathic parkinson disease. This specific druginduced parkinsonism dip mimics idiopathic parkinson s disease with the typical parkinsonian triad but the symptomatology of this disorder is a rather akinetic rigid syndrome with lesser incidence of resting tremor. Druginduced parkinsonism, as its name implies, involves symptoms of parkinsons brought on by medications, such as reserpine, metoclopramide or tetrabenazine. Vascular parkinsonism also known as arteriosclerotic parkinsonism affects people with restricted blood supply to the brain. Once the medications are stopped, the symptoms usually stop, too. Initially reported as a complication of antipsychotics, it was later recognized as a common complication of antidepressants, calcium channel antagonists, gastrointestinal prokinetics, antiepileptic drugs and. For more than half a century, drug induced parkinsonism. Jul 19, 2018 drug induced parkinsonism dip and tardive dyskinesia td are stigmatizing movement disorders associated with exposure to dopamine receptor blocking agents such as antipsychotics, but they differ in their pathophysiology and clinical management. Dip is more common in older patients, as are neurodegenerative diseases. Druginduced parkinsonism is the second most common cause. Differentiating druginduced parkinsonism from parkinsons. Patients with pure drug induced parkinsonism will have normalization of their radioactive dopa uptake in the basal ganglia after elimination of precipitating drugs. Druginduced parkinsonism is defined as the appearance of parkinsonism on treatment with pharmaceutical agents. Antiemetics and druginduced parkinsonism in a gynonc.
Mar 31, 2012 drug induced parkinsonism dip is the secondmostcommon etiology of parkinsonism in the elderly after parkinsons disease pd. Druginduced movement disorders include druginduced parkin sonism dip, tardive dyskinesia td, tardive dystonia, akathisia, myoclonus, and tremor. Druginduced parkinsonism can be difficult to distinguish from parkinsons, though the tremors and postural instability may be less severe. Prevalence and incidence of parkinsons disease and drug. The history of mptpinduced parkinsonism in young adults who inadvertently injected themselves with this compound is well known. The history of mptp induced parkinsonism in young adults who inadvertently injected themselves with this compound is well known.
Druginduced parkinsonism as a risk factor for parkinsons disease. Jul 23, 2019 the form of parkinsonism that develops after being treated with particular medications is known as drug induced parkinsonism. These offending drugs include antipsychotics, calcium channel blockers, and gastrointestinal motility drugs 2. Idiopathic parkinsons disease ipd vs drug induced parkinsonism over the time biggest challenge encountered in dip is to differentiate it from ipd. This article discusses the drugs implicated, as well as the epidemiology, pathophysiology, clinical features, and management of drug induced parkinsonism. Dysphagia is a potentially lifethreatening complication of drug induced parkinsonism. For several decades, drugs that can induce parkinsonism have been reported. Druginduced parkinsonism journal of clinical neurology. Druginduced parkinsonism is more prevalent in older people and is twice as common in women than men. Mar 01, 2019 drug induced parkinsonism is the most common secondary cause, followed by vascular parkinsonism arteriosclerotic pseudoparkinsonism which generally affects the lower body and involves gait disturbance and cognitive impairment. However, in any parkinsonian patient, one must obtain a. Drug induced parkinsonism dip has been deemed the most prevalent form of secondary parkinsonism in the western world and the second most common cause of parkinsonism after idiopathic parkinsons disease pd. About 7% of people with parkinsonism developed symptoms as a result of side effects of medications, mainly neuroleptic antipsychotics especially the phenothiazines such as perphenazine and chlorpromazine, thioxanthenes such as flupenthixol and zuclopenthixol and butyrophenones such as haloperidol, and rarely, antidepressants. Druginduced parkinsonism dip is the second most frequent cause of parkinsonism after idiopathic parkinson disease pd ipd 1,2.
However, in any parkinsonian patient, one must obtain a careful medical and medication history, as druginduced parkinsonism dip is often reversible, especially if the offending drug is discontinued early. However, in any parkinsonian patient, one must obtain a careful medical and medication history, as drug induced parkinsonism dip is often reversible, especially if the offending drug is discontinued early. Prescribed drugs and neurological complications journal of. In all cases of parkinsonism, there is a disturbance in the dopamine systems of the basal ganglia a part of the brain that controls movement.
Differentiating druginduced parkinsonism from parkinsons disease. Drug induced dysphagia the first reported case of drug induced dysphagia occurred in 1970. Lowdose clozapine for the treatment of druginduced psychosis in parkinsons disease. Parkinsonism is seen frequently in patients with psychiatric conditions. Mptpinduced parkinsonism an overview sciencedirect topics. Jan 12, 2018 doctors call this condition drug induced parkinsonism. The incidence of druginduced parkinsonism increases with age. Druginduced parkinsonism dip and tardive dyskinesia td are stigmatizing movement disorders associated with exposure to dopamine receptor blocking agents such as antipsychotics, but they differ in their pathophysiology and clinical management. Treatment for one may worsen the other, and there are important diagnostic clues that assist in making an accurate assessment and instituting a. Druginduced parkinsonism dip is the secondmostcommon etiology of parkinsonism in the elderly after parkinson s disease pd. Sometimes people who have had a mild stroke may develop this form of parkinsonism. Druginduced parkinsonism dip can be difficult to diagnose. The most common cause of parkinsonism is idiopathic parkinsons disease pd but a number of cases are due to secondary parkinsonism for which there are multiple causes.
Druginduced parkinsonism must always be suspected when parkinsonian symptom like rigidity, tremor, or postural instability appear in patients receiving drug. Druginduced parkinsonism dip is the second most common cause of parkinsonism after idiopathic parkinsons disease ipd. It is usually the side effect of drugs that affect dopamine levels in the brain, such as antipsychotics, some calcium channel blockers and stimulants like amphetamines and cocaine. While patients with unmasking of an underlying parkinsonism will have persistent diminished uptake after elimination of the precipitating medication burn and brook, 1993. Such reactions varyfrom acute dystonic reaction, akathisia, and tardive dyskinesia all the way up to fullblown parkinsonism. Druginduced parkinsonism some drugs can cause parkinsonism. Drug induced parkinsonism dip is the second most common cause of parkinsonism after idiopathic parkinsons disease ipd.
Drug induced parkinsonism can be difficult to distinguish from parkinson s, though the tremors and postural instability may be less severe. Druginduced parkinsonism and other movement disorders. Descriptions evolved until the term parkinsonism now refers to a syndrome characterized by the presence of tremor, rigidity, and bradykinesia in addition to loss of postural reflexes and freezing. This disorder is usually dosedependent and related to individual susceptibility to neuroleptics. Druginduced parkinsonism information sheet pdf, 157kb. What is druginduced parkinsonism, know its characteristics. Parkinsons disease pd and is often mistaken for this dis order. Dysphagia is a potentially lifethreatening complication of druginduced parkinsonism. Drug induced parkinsonism is defined as the appearance of parkinsonism on treatment with pharmaceutical agents.
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