A case of lithium-induced parkinsonism presenting with typical motor symptoms of Parkinson's disease in a bipolar patient

Abstract

Lithium is a mood stabilizer rarely associated with drug-induced parkinsonism (DIP). We present a case of an elderly woman with bipolar disorder who developed parkinsonian symptoms after chronic lithium administration despite therapeutic serum levels. Upon evaluation, classic parkinsonian signs of muscle rigidity, tremor, bradykinesia, freezing of gait, and cognitive decline were observed. Initially, she was diagnosed with Parkinson's disease (PD); however, DaTscan SPECT imaging clarified the diagnosis as DIP. As the daily lithium dosage was reduced, the patient's motor symptoms improved. This report emphasizes close monitoring of lithium levels in geriatric populations and the need to consider lithium-induced parkinsonism when PD symptoms appear in chronic lithium users.

Acute and Prophylactic Management of Postictal Agitation in Electroconvulsive Therapy

“…There are several theories to explain this effect, including greater brain lithium concentration because of the increased permeability of the blood-brain barrier during ECT, 10 alterations in the balance of the convulsant and anticonvulsant effects of both lithium and ECT, 11 lithium-induced enhancements in cholinergic sensitivity normally reduced by ECT, 12 and lithium's interference with the inositol lipid cycle 13 . This is of particular concern in older patients, where increased blood-brain barrier permeability and decreased renal clearance may exacerbate the effects of lithium 14 . Lithium increases the risk of agitation and should be held or discontinued before the ECT procedure, although there is strong evidence for the use of lithium post-ECT to prevent relapse 15 …”

“…13 This is of particular concern in older patients, where increased blood-brain barrier permeability and decreased renal clearance may exacerbate the effects of lithium. 14 Lithium increases the risk of agitation and should be held or discontinued before the ECT procedure, although there is strong evidence for the use of lithium post-ECT to prevent relapse. 15…”

Parkinsonism in the psychiatric setting: an update on clinical differentiation and management

“…While antipsychotic medication is a common cause of DIP, other medications have been causally associated with parkinsonism including antiemetic agents,5 antidepressants (selective serotonin reuptake inhibitors),15 lithium16 and calcium channel blocking agents 5…”

Polypharmacy-induced cognitive dysfunction and discontinuation of psychotropic medication: a neuropsychological case report

“…8,23,24 mostly lacking, making cases of iatrogenic conditions challenging for clinicians to identify. Evidence suggests that lithium-induced and polypharmacy-related iatrogenic neurological conditions are challenging to identify at their early stages, 15,28 and they are frequently misdiagnosed as aphasia, 29,30 Alzheimer's disease, 31 frontotemporal dementia, 32 Parkinson's disease, 33 or other forms of progressive brain disorder. 7,[34][35][36][37] Detailed neuropsychological assessments describing the recovery of cognitive function after drug discontinuation are similarly rare.…”