Substantia Nigra Echogenicity Predicts Response to Drug Withdrawal in Suspected Drug‐Induced Parkinsonism

Abstract

Introduction: Response to drug withdrawal in patients with suspected drug-induced parkinsonism (DIP) is of prognostic and therapeutic importance, but cannot be predicted solely on clinical information. The aim of this study was to validate SN hyperechogenicity (SN+) assessed by transcranial sonography as a predictor of response to drug withdrawal in this group of patients. Methods: Patients were diagnosed according to previously published criteria and prospectively included in the study. All patients were followed until complete recovery of parkinsonian symptoms or at least for 6 months after discontinuation of the offending drug and then diagnosed as DIP or parkinsonism following neuroleptic exposure (PFNE). Transcranial sonography (TCS) findings were compared with the clinical diagnosis. Results: Sixty patients comprised the group for the final analysis. Sixteen patients were classified as PFNE and 44 as DIP. The area of SN echogenicity was significantly increased in the PFNE group (0.23 cm 2 ; standard deviation [SD]: 0.04), compared to the DIP group (0.14 cm 2 ; SD, 0.05; one-way analysis of variance; P < 0.001). Normal SN was significantly associated with complete recovery after withdrawal of the parkinsonism-inducing drug (P < 0.0005). Accuracy of SN+ to distinguish PFNE from DIP was: sensitivity 81.2%; specificity 84.1%; positive predictive value 47.4%; and negative predictive value 96.2%. Conclusions: We believe that SN+ assessed with TCS is a valid prognostic marker in the setting of suspected DIP. It is a nonexpensive, feasible technique that can be implemented for proper counseling and guidance of treatment decisions.

An unusual gait disorder at the Emergency Department: role of the quantitative assessment of parenchymal transcranial Doppler sonography

“…However, the pTCS signs of a marked bilateral hyperechogenicity of both SN and CN did not support a DIP. Indeed, according to previous studies (24), although SN hyperechogenicity can be also observed in DIP, none of the DIP patients showed the CN hyperechogenicity. In the present case, we supposed that the improvement of rigidity and the worsening of gait might be correlated to the discontinuation of amisulpride and to the disease progression, respectively.…”

Updated Perspectives on the Management of Drug-Induced Parkinsonism (DIP): Insights from the Clinic

“…Additionally, normal echogenicity was associated with complete recovery after drug withdrawal. 105 One prospective study found shortest onset of DIP among patients treated with typical neuroleptics (1.2 ± 0.7 months), while those treated with calcium channel blockers (CCB), flunarizine or cinnarizine, had the longest time to onset (6 ± 1.4 months). The duration of parkinsonism was also longest in the CCB group (3.2 years).…”