Drug-induced parkinsonism in a movement disorders unit: A four-year survey

Jiménez‐Jiménez, Félix Javier; Ortı́-Pareja, M; Ayuso‐Peralta, Lucía; Gasalla, Teresa; Cabrera‐Valdivia, Francisco; Vaquero, Antonio; Tejeiro, José Barea; E, García-Albea

doi:10.1016/1353-8020(96)00013-2

Cited by 37 publications

(22 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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 15,41,58,59…”

Section: Diagnosis Of Dip and The Role Of Dat Imagingmentioning

confidence: 99%

Drug-Induced Parkinsonism

2012

View full text Add to dashboard Cite

Drug-induced parkinsonism (DIP) is the second-most-common etiology of parkinsonism in the elderly after Parkinson's disease (PD). Many patients with DIP may be misdiagnosed with PD because the clinical features of these two conditions are indistinguishable. Moreover, neurological deficits in patients with DIP may be severe enough to affect daily activities and may persist for long periods of time after the cessation of drug taking. In addition to typical antipsychotics, DIP may be caused by gastrointestinal prokinetics, calcium channel blockers, atypical antipsychotics, and antiepileptic drugs. The clinical manifestations of DIP are classically described as bilateral and symmetric parkinsonism without tremor at rest. However, about half of DIP patients show asymmetrical parkinsonism and tremor at rest, making it difficult to differentiate DIP from PD. The pathophysiology of DIP is related to drug-induced changes in the basal ganglia motor circuit secondary to dopaminergic receptor blockade. Since these effects are limited to postsynaptic dopaminergic receptors, it is expected that presynaptic dopaminergic neurons in the striatum will be intact. Dopamine transporter (DAT) imaging is useful for diagnosing presynaptic parkinsonism. DAT uptake in the striatum is significantly decreased even in the early stage of PD, and this characteristic may help in differentiating PD from DIP. DIP may have a significant and longstanding effect on patients' daily lives, and so physicians should be cautious when prescribing dopaminergic receptor blockers and should monitor patients' neurological signs, especially for parkinsonism and other movement disorders.

show abstract

Section: Diagnosis Of Dip and The Role Of Dat Imagingmentioning

confidence: 99%

Drug-Induced Parkinsonism

2012

View full text Add to dashboard Cite

show abstract

“…However, such information was not also available in the NHIRD. However, more researchers found that patients did not fully recover after being exposed to cz and fz [8, 14]. Diseases that may cause parkinsonism or dystonia were excluded from this study.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, ICD-9-CM codes for Parkinson’s disease were included into analysis considering that fz- or cz-induced parkinsonism may be misclassified as IPD. Third, the incidence of akathisia, one of the EPSEs induced by fz or cz [12, 14] could not be obtained. There is no specific ICD-9-CM code for akathisia.…”

Section: Discussionmentioning

confidence: 99%

Extrapyramidal symptoms after exposure to calcium channel blocker-flunarizine or cinnarizine

Jhang

Huang

Nfor

et al. 2017

Eur J Clin Pharmacol

View full text Add to dashboard Cite

PurposeFlunarizine (fz) and cinnarizine (cz) have well-known extrapyramidal side effects (EPSEs). The aim of this study was to evaluate the incidence and occurrence time of cz- and fz-related EPSEs.MethodPatients who took fz or cz for more than 1 month were identified from the longitudinal health insurance database 2005 and 2010. Excluded were patients with any of the underlying diseases that may cause parkinsonism. Drug-induced EPSEs were defined as the new diagnosis of parkinsonism, dyskinesia, or secondary dystonia during drug use or within 3 months after discontinuing the medication. Age- and sex-matched controls were included in this study.ResultsRecruited for analysis were individuals who took fz (n = 26,133) and cz (n = 7186). The incidence rates of fz- and cz-induced EPSEs were 21.03 and 10.3 per 10,000 person-months, respectively. The hazard ratios (HRs) of EPSEs among fz and cz subjects were 8.03 (95% CI 6.55–9.84) and 3.41 (95% CI 2.50–4.63) when compared with the control individuals. Both fz and cz patients had a higher cumulative incidence of EPSEs than their control individuals (p < 0.001). Among subjects who took fz, the incidence of EPSEs was higher in the second than first year of drug exposure (45.59 vs 21.03 per 10,000 person-months).ConclusionsFz and cz significantly increased the risk of parkinsonism, dyskinesia, and dystonia. Potential benefits and risks should be weighed when considering long-term use of these drugs especially fz.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-017-2247-x) contains supplementary material, which is available to authorized users.

show abstract

“…DIP was diagnosed according to the following criteria10: (1) the presence of at least two of the four cardinal symptoms of parkinsonism, (2) absence of parkinsonism prior to exposure to the offending drugs, (3) disappearance or significant improvement in the parkinsonism within 12 months after withdrawal of the offending drugs, and (4) no better explanation for the parkinsonism. To rule out patients with PD that was unmasked by the offending drugs, 18 F-labelled N-3-fluoropropyl-2-carbomethoxy-3β-(4-iodophenyl) nortropane ( 18 F-FP-CIT) positron emission tomography (PET) scans were performed, and the subjects with decreased DAT availability in the basal ganglia were excluded.…”

Section: Methodsmentioning

confidence: 99%