Differentiating drug-induced parkinsonism from Parkinson's disease: An update on non-motor symptoms and investigations

Brigo, Francesco; Erro, Roberto; Marangi, Antonio; Bhatia, Kailash P.; Tinazzi, Michèle

doi:10.1016/j.parkreldis.2014.05.011

Cited by 101 publications

(72 citation statements)

References 34 publications

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“…It can be significantly impaired in DLB, mildly impaired in MSA, but within normal range in PSP [26,27], explaining why the olfactory test cannot differentiate APS from PD or Non-parkinsonism. Other studies indicate that testing the olfactory function may be helpful in distinguishing PD from vascular parkinsonism or druginduced parkinsonism [28,29]. In this study, we could not recruit enough patients to these two subgroups in order to validate this argument.…”

Section: Olfactionmentioning

confidence: 81%

The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes

et al. 2015

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The aim of the study was to compare the efficacy of olfactory testing and presynaptic dopamine imaging in diagnosing Parkinsons disease (PD) and atypical parkinsonian syndromes (APS); to evaluate if the combination of these two diagnostic tools can improve their diagnostic value. A prospective investigation of 24 PD patients, 16 APS patients and 15 patients with non-parkinsonian syndromes was performed during an 18-month period. Single photon emission computed tomography with the presynaptic radioligand I-123-FP-CIT (DaTSCAN (R)) and olfactory testing with the Brief 12-item Smell Identification Test (B-SIT) were performed in all patients. DaTSCAN was analysed semi-quantitatively, by calculating two different striatal uptake ratios, and visually according to a predefined ranking scale. B-SIT score was significantly lower for PD patients, but not significantly different between APS and non-parkinsonism. The visual assessment of DaTSCAN had higher sensitivity, specificity and diagnostic accuracy compared to olfactory testing. Most PD patients (75 %) had visually predominant dopamine depletion in putamen, while most APS patients (56 %) had visually severe dopamine depletion both in putamen and in caudate nucleus. The combination of DaTSCAN and B-SIT led to a higher rate of correctly classified patients. Olfactory testing can distinguish PD from non-parkinsonism, but not PD from APS or APS from non-parkinsonism. DaTSCAN is more efficient than olfactory testing and can be valuable in differentiating PD from APS. However, combining olfactory testing and DaTSCAN imaging has a higher predictive value than these two methods separately.

Funding Agencies|Ostergotland County Council (ALF); Swedish Parkinsons Foundation

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Section: Olfactionmentioning

confidence: 81%

The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes

et al. 2015

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Funding Agencies|Ostergotland County Council (ALF); Swedish Parkinsons Foundation

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“…Previous studies have attempted to identify certain clinical features such as presence of tremor, observable dyskinesias and symmetry of symptoms to try to aid differentiation between DIP and IPD and these are summarised in Table 1 [3,4]; however, using clinical features alone can be unreliable as valproateinduced parkinsonism can be indistinguishable from idiopathic PD, and can present with marked asymmetry, rest tremor and akinetic-rigidity [5].…”

Section: Discussionmentioning

confidence: 99%

“…DaTSCAN's are useful when there is diagnostic uncertainty between DIP and IPD [4]. Patients with valproateinduced parkinsonism have normal DaTSCAN's suggesting that dopaminergic neuronal loss is not the underlying mechanism-and this can help differentiate pure DIP from IPD or other degenerative causes of parkinsonism.…”

Section: Discussionmentioning

confidence: 99%

Clinically silent idiopathic Parkinson’s disease unmasked by valproate use: a brief report

Batley

Ellis

2014

Aging Clin Exp Res

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Valproate is an important but uncommon cause of drug induced parkinsonism in the elderly. The development of symptoms after valproate onset is unpredictable, and severity of symptoms is unrelated to plasma levels. However, though the majority of cases improve after drug cessation, parkinsonian symptoms can persist and should prompt investigation into underlying degenerative parkinsonism, as valproate can unmask idiopathic Parkinson's disease in susceptible individuals. This case describes a patient on chronic valproate therapy developing a severely disabling akinetic-rigid syndrome, only partially reversed on stopping valproate. We hypothesise that an increase in valproate dosage unmasked clinically silent Parkinson's disease. The patient made an excellent recovery following cessation of valproate and commencement of dopaminergic therapy.

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“…[67][68][69] In a French elderly cohort of 2,991 noninstitutionalized individuals, neuroleptic exposure increased 3.2-fold the risk to develop probable PD. 70 The risk was significant for benzamides and the calcium channel blockers flunarizine and cinnarizine.…”

Section: Other Clinical Issues Persistent Parkinsonism Following Neurmentioning

confidence: 99%

Drug-induced parkinsonism: diagnosis and management

Blanchet

Kivenko²

2016

JPRLS

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Drug-induced parkinsonism (DIP) has been known for >60 years. It is the second leading cause of parkinsonism, but still underdiagnosis is likely to influence reported incidence figures. Since DIP is clinically undistinguishable from Lewy-body Parkinson’s disease, any new case of parkinsonism should prompt the search for an offending antipsychotic, hidden neuroleptic, or nonneuroleptic agent that may produce DIP. DIP is reversible upon drug withdrawal in most cases. There is no consensus regarding the duration of the recovery period to allow motor signs to fully remit in order to confirm the diagnosis of DIP following removal of the causative agent, but a drug-free interval of at least 6 months is generally recommended. Interestingly, up to 30% of DIP cases may show persisting or worsening motor signs beyond 6 months following drug withdrawal or adjustment, due to complex postsynaptic and presynaptic factors that may variably interact to negatively influence nigrostriatal dopamine transmission in a so-called “double-hit” hypothesis. The condition significantly impacts on quality of life and increases the risks of morbidity and mortality. Management is challenging in psychiatric patients and requires a team approach to achieve the best outcome

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Differentiating drug-induced parkinsonism from Parkinson's disease: An update on non-motor symptoms and investigations

Cited by 101 publications

References 34 publications

The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes

The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes

Clinically silent idiopathic Parkinson’s disease unmasked by valproate use: a brief report

Drug-induced parkinsonism: diagnosis and management

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