Motor and non-motor features of Parkinson's disease that predict persistent drug-induced Parkinsonism

Morley, James F.; Pawlowski, Stephanie; Kesari, Adhithi; Maina, Ivy W.; Pantelyat, Alexander; Duda, John E.

doi:10.1016/j.parkreldis.2014.03.024

Cited by 34 publications

(30 citation statements)

References 25 publications

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“…Nonmotor functions were not specifically identified in our cases; however, recent work suggests that nonmotor features, such as disordered olfaction and cardiac denervation, may predict those who will go on to develop persistent PS . Autopsy verification has, however, not been performed in these cases.…”

Section: Discussioncontrasting

confidence: 57%

Neuroleptic‐inducedParkinsonism:Clinicopathological study

et al. 2015

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BackgroundDrug‐induced parkinsonism is a well‐known complication of several different drugs—the most common being neuroleptic‐induced parkinsonism. However, very few autopsies have been reported in such cases.MethodsPatients assessed at Movement Disorders Clinic Saskatchewan are offered brain autopsy. Detailed clinical records are kept.ResultsBrains were obtained from 7 drug‐induced parkinsonism patients with parkinsonian symptom onset coinciding with use of drugs known to produce parkinsonism. Six were on antipsychotics and 1 was on metoclopramide. Three cases were treated with levodopa for parkinsonism. In two cases, parkinsonian features reversed after stopping the offending agent. Both had autopsy evidence of preclinical PD. In 4 of the remaining 5, dopamine‐blocking drugs were continued until death. In 4 of those 5, brain histology revealed no cause for the parkinsonism, but 1 had mild SN neuronal loss without Lewy bodies.ConclusionThis study shows that reversal of parkinsonism after discontinuing offending drugs does not indicate absence of underlying pathology. Neuroleptics can unmask preclinical PD in patients with insufficient SN damage for the disease to manifest clinically. Though the mechanism of sustained parkinsonian features after discontinuing neuroleptics remains to be established, it is unlikely that dopamine receptor block leads to retrograde SN neuronal degeneration. Furthermore, l‐dopa does not appear to be toxic to SN. © 2015 International Parkinson and Movement Disorder Society

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Section: Discussioncontrasting

confidence: 57%

Neuroleptic‐inducedParkinsonism:Clinicopathological study

et al. 2015

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“…Furthermore, true prevalence rates may be even higher than reported in these studies, as the disorder is frequently unrecognized or misdiagnosed as idiopathic Parkinson’s disease (iPD) ( 5 – 7 ). DIP is particularly burdensome in psychiatric patients, as it can result in significant morbidity, disability, and treatment non-compliance ( 6 , 8 , 9 ). Therefore, recognition of the clinical presentation of DIP in psychiatric patients is essential for adequate diagnosis and treatment ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Asymmetric Drug-Induced Parkinsonism and Psychopathology: A Prospective Naturalistic Study in Long-Stay Psychiatric Patients

2018

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BackgroundDrug-induced parkinsonism (DIP) is the most common movement disorder induced by antipsychotics. Although DIP is mostly symmetric, asymmetric DIP is reported in a substantial part of the patients. We investigated the frequency of motor asymmetry in DIP and its relationship to the severity of psychopathology in long-stay psychiatric patients.MethodsWe obtained data from a cohort study of 207 long-stay psychiatric patients on the frequency and risk factors of tardive dyskinesia, akathisia, tardive dystonia, and DIP. From July 2003 to May 2007 (mean follow-up, 1.1 year) drug-induced movement disorders were assessed at least two times in each patient, with a frequency of persistent DIP of 56.2%. All patients who had at least one time parkinsonism in the upper/lower limb(s) were included for analyses (190 patients, 79 women; mean age, 48.0 ± 12.9 years). The Unified Parkinson Disease Rating Scale motor scale was used to calculate the frequency of asymmetric parkinsonism. Multilevel mixed models were built to explore the relationship between asymmetry in parkinsonism and the severity of psychopathology, measured on the Clinical Global Impression-Schizophrenia scale severity index (CGI-SCH SI).ResultsThe frequency of asymmetric parkinsonism was 20.8%. Asymmetry in parkinsonism was associated with symptom severity on all CGI-SCH SI scales (β range, 0.37–3.74) and significantly associated with the positive symptom scale (β, 3.74; 95% CI, 0.35–7.31).ConclusionDIP is asymmetric in a substantial part of patients. Asymmetric presentation of DIP is of clinical relevance as it is related to the severity of psychopathology and may alert the clinician of more severe psychopathology. Future research is recommended to provide insight into the neuropsychopathology and clinical value of asymmetric parkinsonism for psychiatric patients.

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“…Anosmia and rapid eye movement sleep behavior disorder are not typical of DIP. 34,61 Abnormal olfactory testing in DIP correctly predicted those subjects displaying persistent signs after drug withdrawal 35 or abnormal 123 I-metaiodobenzylguanidine (sympathetic neuron imaging ligand) cardiac scintigraphy suggestive of an underlying neurodegenerative process. …”

Section: Clinical Presentation and Associated Featuresmentioning

confidence: 99%

“…62 Autonomic complaints, including constipation and urinary and sexual dysfunction, are more common in PD than in DIP 35,63 and relatively more frequent in persistent DIP than in reversible DIP. 63 The prevalence of restless legs syndrome in DIP relative to PD is unknown.…”

Section: Blanchet and Kivenkomentioning

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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Motor and non-motor features of Parkinson's disease that predict persistent drug-induced Parkinsonism

Cited by 34 publications

References 25 publications

Neuroleptic‐inducedParkinsonism:Clinicopathological study

Neuroleptic‐inducedParkinsonism:Clinicopathological study

Asymmetric Drug-Induced Parkinsonism and Psychopathology: A Prospective Naturalistic Study in Long-Stay Psychiatric Patients

Drug-induced parkinsonism: diagnosis and management

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