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What Drugs Can Induce Parkinsonism

Some Cases Of Parkinsonism Can Be Reversed Others Cannot

Will stopping of offending drug improve Drug Induced Parkinsonism? – Dr. Guruprasad Hosurkar

In most cases, drug-induced parkinsonism can be reversed once the medication causing the problem is eliminated. However, it can take some time for an individual to return to normal. Depending on the medication and its effects, it can take anywhere from 4-18 months for DIP to resolve itself. In some cases, however, parkinsonism may continue even after the medication has been stopped for more than 18 months. This happens when an individual already has a dopamine deficit that was not caused by the medication. In these cases, that individual was already going to develop PD at some point, however DIP accelerated the process.

Dr. Kashouty, a diplomate of the American Board of Psychiatry and Neurology , practices general neurology with fellowship trained specialization in clinical neurophysiology. Dr. Kashouty finds the form and function of the nerves and muscles the most interesting part of neurology, which is what led him to specialize in neurophysiology with more emphasis on neuromuscular conditions. He treats all neurological diseases, but his main focus is to treat and manage headaches, movement disorders and neuromuscular diseases.

What Is The Difference Between Drug Induced Parkinsons Disease And Typically Occurring Parkinsons Disease

It has been seen that drug-induced Parkinsonism usually occur on both sides of your body while usual Parkinsons starts from one side of the body. Apart from this, the medication-induced signs generally are seen to go away after the medicine is finished. However, it may take few months to stop, but is does stop eventually. On the contrary, the typically occurring Parkinsons disease cannot be reversed. Another thing to be kept in mind is that medication-induced Parkinsons disease is not progressive, unlike the typical Parkinsons disease.

Is Drug Induced Parkinsonism Reversible

druginduced parkinsonismreversiblemedicationdruginduced parkinsonism

DIP usually resolves within weeks to months after stopping the offending drug however, parkinsonism may persist or progress in 10-50% of patients. In DIP patients classified as type 2, the persistence of parkinsonism may be due to permanent DRBA-induced damage to dopamine receptors.

Similarly, how is drug induced Parkinsonism treated? Drug-induced parkinsonism

  • Neuroleptic or antipsychotic drugs used to treat schizophrenia and other psychiatric problems.
  • Prochlorperazine used to treat dizziness and nausea.
  • Metoclopromide used to treat nausea and indigestion.
  • One may also ask, what drugs can cause drug induced Parkinsonism?

    Medication DIP OffendersYet the atypical or second-generation antipsychotics such as risperidone, particularly at higher doses, can have the same impact. Along the same line, medications such as prochlorperazine and metoclopramide that impact the dopaminergic system can cause a druginduced parkinsonism.

    Can parkinsonism reversed?

    Parkinson’s is caused by the loss of dopamine producing brain cells. There are currently no treatments that can slow or stop Parkinson’s, but cell replacement could help to reverse the condition. Ongoing research in people with Parkinson’s is attempting to transplant pre-made cells into the right part of the brain.

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    Study Subjects And Demographic Data

    A total of 52 DIP patients who showed a visually normal DAT density on 18F-FP-CIT PET were selected from historical medical record. However, two patients who had a DAT density slightly below the cut-off were excluded. Among the remaining 50 patients, nine had recovered partially from parkinsonism, and the other 41 had recovered completely .

    The demographic characteristics of the subjects are shown in Table 2, and the original data are presented in S1 File. There was no significant difference in sex distribution or age at the time of the PET scan between the groups. The PR and CR groups were similar in age at onset of parkinsonian symptoms, the time from onset of parkinsonism to PET scan, and UPDRS motor scores. The composition of the offending drugs was also comparable.

    Ethics Approval And Consent To Participate

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    The study has been approved by the Bioethics Committee of the Medical School of the National and Kapodistrian University of Athens and was conducted in accordance with the 1964 Helsinki declaration and its later amendments. The authors state that the patients have given their written informed consent for participation in the study. They were deemed by the head psychogeriatrician capable of ethically and medically consenting for their participation.

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    Biological Basis Of Iatrogenic Movement Disorders

    The biological basis of the movement disorders is complex. However, those listed above as secondary to medication are characterised by the action of drugs on central nuclei and in particular pathways and nuclei associated with the basal ganglia, a functional unit located at the base of the forebrain.

    The basal ganglia have principal connections to the cortices and thalamus. Although involved in multiple functions including cognition and emotional function, it is their role in the control of involuntary movements that is relevant to this chapter. The other functions, though, are clinically important and discussed elsewhere in this book. At rest, the structures of the basal ganglia can be considered to provide a tonic inhibition of motor activity. This inhibition is released through conscious activity via an increased release of dopamine from the substantia nigra, thereby allowing voluntary control of motor activity in the necessary area.

    However, cholinergic pathways elsewhere are involved in cognition, vigilance and emotional modulation and degenerate in Parkinsons disease while anticholinergic medication may therefore be associated with an improvement in movements, it is at the expense of deterioration in cognition in this disease, as well as in patients with psychosis, where anticholinergic medication may additionally mediate confusion and psychotic symptoms.

    Who Are At Risk Of Developing Drug Included Parkinsonism

    Some patients may be at a higher risk of developing medication-induced Parkinson

    ism than others. Some of the risks include-

    Women: Women are seen to be two times as much at risk of having drug inducing Parkinsons disease than men.

    AIDS Patients: People with AIDS are at a higher risk.

    Family History: Patients having a family history Parkinsons disease are at a higher risk of having drug induced Parkinsonism.

    Elderly: Since elder people are usually on multiple medicines, they are at risk of having drug induced Parkinsonism.

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    Which Drugs Can Cause Parkinsonism

    Typical antipsychotic , are the most common causative agents of drug-induced parkinsonism. It has been seen that certain atypical antipsychotics, which are thought to be free from extrapyramidal symptoms, can also induce Parkinsonism. Besides the gastrointestinal motility drugs, antipsychotics, antiepileptic drugs, and calcium channel blockers can lead to drug-induced Parkinsonism.

    The most common drugs that cause Parkinsonism are listed below:

    • Antiemetics 3

    The Connection Between Pd And Drug

    Neuroleptic Induced Parkinsonism

    In addition to potentially causing parkinsonism in the general population, these medications should definitely be avoided in people who have parkinsonism from other causes, such as PD. APDA has created a list of Medications to be Avoided or Used With Caution in Parkinsons Disease. It is important to note that there are anti-psychotics and anti-nausea medications which do not cause parkinsonism and can be used safely by people with PD.

    Sometimes, a person without a diagnosis of PD is prescribed a medication which leads to a side effect of drug-induced parkinsonism. The prescribing physician may stop the new medication, but the parkinsonism does not resolve. The patient remains off the medication with continuing symptoms, and eventually is given a diagnosis of PD. In this scenario, that person most likely had dopamine depletion in the brain which had not yet manifested as a clinical symptom. The prescription medication that blocked the dopamine receptor, was the proverbial straw that broke the camels back, inducing the full-fledged symptoms of dopamine depletion and revealing that the person did in fact have PD.

    The differences of PD vs drug-induced parkinsonism

    There are key differences to note between parkinsonism from PD and parkinsonism as a side effect of medication.

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    Can Drug Induced Parkinsonism Be Prevented

    Although there is no surety in the prevention of drug-induced parkinsons disease, but efforts may be made to check the dosage of drugs so prescribed-

    Be Cautious with Antipsychotics: The patient or in some cases the caregiver should make sure that antipsychotic drugs are given at their least effective dosage.

    Inform the Doctor: The doctor should be informed well before in case the patient already has symptoms of Parkinsons disease so that they do not appear to get worse with the starting of some prescribed drugs.

    Abrupt Stoppage of Medicine: It is never a wise decision to stop taking a medicine by oneself. It is important to talk to the doctor in case of any concerns.

    How Parkinsonism Differs From Parkinsons Disease

    Parkinsons disease is one of many types of parkinsonism. Its caused by a loss of cells in the part of your brain that produces the neurotransmitter dopamine.

    Parkinsons disease and the different types of parkinsonism progress in different ways. Some may progress more rapidly than Parkinsons disease. Others, like secondary parkinsonism, may be reversible.

    The conditions also respond differently to treatments. For instance, someone who has a type of parkinsonism may not respond to the drug levodopa, which is commonly used for Parkinsons disease.

    It can be hard to tell the difference between types of parkinsonism. Heres a look at some of the identified categories of parkinsonism with their typical symptoms and treatments.

    • involuntary muscle contractions


    No treatment has been found to slow the progression of corticobasal syndrome. Parkinsons drugs are generally ineffective but may help manage stiffness in some people.

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    Dementia With Lewy Bodies

    DLB is second only to Alzheimers as the most common cause of dementia in the elderly. It causes progressive intellectual and functional deterioration. In addition to the signs and symptoms of Parkinsons disease, people with DLB tend to have frequent changes in thinking ability, level of attention or alertness and visual hallucinations. They usually do not have a tremor or have only a slight tremor. The parkinsonian symptoms may or may not respond to levodopa.

    Parkinsonism Vs Parkinsons Disease


    Parkinsonism refers to a cluster of symptoms that mimic the movement problems caused by Parkinsons disease. Its sometimes referred to as atypical Parkinsons disease, secondary parkinsonism, or Parkinsons plus.

    Parkinsons disease is a chronic, neurodegenerative brain disorder. In addition to problems with movement, Parkinsons disease causes non-motor symptoms that arent caused by drug-induced parkinsonism. They include:

    Another key difference between drug-induced parkinsonism and Parkinsons disease is symmetry. Drug-induced parkinsonism usually affects both sides of the body equally. Parkinsons disease affects one side of the body more than the other.

    Parkinsonism can be caused by medications, repeated head trauma, and environmental toxins. It can also be caused by neurological disorders, including Parkinsons disease. Other neurological conditions that cause parkinsonism include:

    • progressive supranuclear palsy

    These medications dont cause resting tremors. Rather, they cause:

    • Action tremors. These occur in a body part thats moving, not a body part thats resting.
    • Postural tremors. These occur when a body part is forced to withstand gravity, such as when arms are outstretched or legs are raised.

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    How To Differentiate Between Drug Induced Parkinsonism And Parkinsonism Disease

    Drug-induced Parkinsonism can mimic features of Parkinsonism disease and other parkinsonian syndromes. However, there are certain clinical features that help in differentiating drug-induced Parkinsonism from Parkinsonism disease. Drug-induced Parkinsonism has a sudden and acute onset of symptoms which can be directly correlated with introduction of a new drug in the system. Drug related Parkinsonism presents itself clinically within a few days to 3 months after starting a new drug. Parkinsons disease is usually characterized by asymmetrical signs and symptoms, even at advanced stages. Drug-induced Parkinsonism usually presents itself symmetrically. Freezing, which is more common in Parkinsons disease, is a rare occurrence in drug-induced Parkinsonism. Incidence of rest tremor is more evident in drug-induced Parkinsonism than in Parkinsons disease. Studies have also known that drug-induced Parkinsonism is more common in females, whereas Parkinsons disease is more common in males. Drug-induced Parkinsonism responds to anticholinergic drugs, and Parkinsons disease responds to Levadopa.

    What Are The Other Forms Of Medicines That Can Cause Parkinsons Disease

    Some of the other common medicines which can cause Parkinsons disease may include some forms of anti-depressants, anti-nausea drugs, drugs used for the treatment of vertigo, drugs used for epilepsy and anti-arrhythmics. It should be remembered that not all drugs in these classes may cause signs of Parkinsonism. The doctor generally makes the patient aware of the side-effects before prescribing a certain form of drugs. Nevertheless, it is important from the patients part to ask about the side-effects of the prescribed medicines.

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    Treatments And Outcomes Of Dip

    DIP is generally treated by cessation of the offending drugs. Patients who cannot stop taking antipsychotic drugs because of their psychiatric diseases, such as those with schizophrenia or major depressive disorders, may be switched to atypical antipsychotics that have a lower risk of EPS. People who are prescribed dopamine antagonists due to simple GI disturbance, headache, dizziness, or insomnia should stop taking the offending drugs as soon as possible. Anticholinergics including trihexyphenidyl, benztropine, amantadine, and levodopa have been empirically tested for their ability to relieve symptoms of DIP, but this has produced no clear evidence of their effects in DIP patients.,,,,

    Diagnosis Of Dip And The Role Of Dat Imaging

    Medicines causing Drug Induced Parkinsonism – Dr. Guruprasad Hosurkar

    The clinical diagnostic criteria for DIP are defined as 1) the presence of parkinsonism, 2) no history of parkinsonism before the use of the offending drug, and 3) onset of parkinsonian symptoms during use of the offending drug. Since asymmetrical rest tremors are common in many DIP patients and symptoms persist or progress after cessation of the offending drug, patients clinically diagnosed with DIP may include individuals in the preclinical stage of PD whose symptoms were unmasked by the drug.,,,

    DATs are presynaptic proteins in the membrane on terminals of dopaminergic neurons. They take up dopamine from the synaptic cleft projections that extend from the substantia nigra to the striatum. These transporters control dopaminergic transmission by spatial and temporal buffering, rendering the molecule an imaging target in diseases affecting the dopaminergic nigrostriatal pathway. Single-photon-emission computed tomography and positron-emission tomography scans are available using several DAT ligands., SPECT radioligands include 123I-N-3-fluoropropyl-2-carbomethoxy-3-nortropane , 123I-ioflupane, DaTSCAN, and 123I-2-carbomethoxy-3-tropane . PET scans may be superior to SPECT for imaging DATs, in that the lower energy of positrons provides higher resolution, resulting in better image quality with widespread clinical applications. However, most DAT imaging studies, including those in patients with DIP, have utilized SPECT.,-

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    What To Do If Your Senior Has Parkinsons

    If you notice Parkinsons-like symptoms in your older adult, the first thing to do is talk with their doctor. The doctor should review their complete medication history and you should let them know about any other symptoms or changes.

    Important: Dont make any changes to medications without doctor approval that could cause serious problems.

    A Number Of Medications Can Lead To Dip

    Symptoms of Parkinsons disease occur when there is a loss of dopamine neurons in the brain. Dopamine is a neurotransmitter used by the brain to control bodily movements, learn and focus, and feel pleasure and enjoyment. Certain types of medications, known as dopamine antagonists, bind to and block dopamine receptors. When dopamine receptors in the brain are blocked, this can cause parkinsonism to occur. There are a number of medications that can cause DIP, including:

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    What Is Parkinsons Disease

    Parkinsons disease is a neurodegenerative brain disorder that progresses slowly in most people. Symptoms can take years to develop, and most people live for many years with the disease. The symptoms caused by Parkinsons include an ongoing loss of motor control as well as a wide range of non-motor symptoms .

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    Not All Tremors Are Associated With Parkinsonism

    Other than parkinsonism, some medications can also cause drug-induced tremors, which are not associated with parkinsonism. Drug-induced tremors can take the form of postural or action tremors, and they can accompany other PD-like symptoms. Postural tremors occur when the body part is held against gravity, such as when holding something away from the body. An action tremor occurs when the affected body part is moving. Drug-induced tremors also tend to occur on both sides of the body, whereas tremors associated with PD tend to affect one side more than the other. Although similar to DIP, drug-induced tremors differ in that they are not resting tremors. Resting tremors occur only when a limb is at rest and can affect the fingers, hands, feet, or jaw. Resting tremors are also only associated with PD or DIP.

    Common Symptoms Of Drug

    The motor features of PD are often very easy to see via a neurologic exam in a doctors office. Rest tremor for example, is seen in virtually no other illness and can therefore be very important in diagnosing PD. But there is one other common condition that induces the symptoms of PD, including a rest tremor, which must be considered every time PD is being considered as a diagnosis, and that is drug-induced parkinsonism.

    Parkinsonism is not technically a diagnosis, but rather a set of symptoms including slowness, stiffness, rest tremor, and problems with walking and balance. This set of symptoms can be caused by PD, but also can occur as a side effect of certain prescription medications .

    A number of medications can cause parkinsonism because they block the dopamine receptor and thereby mimic the symptoms of PD that are caused by loss of dopamine neurons in the brain. Reviewing a patients medications is therefore a critical step for a neurologist when seeing someone with parkinsonism. Anti-psychotics and anti-nausea treatments make up the bulk of the problematic medications, although there are other medications that can also cause parkinsonism. The primary treatment for this type of parkinsonism is weaning off of the offending medication, if possible.

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