Prolonged Drug-Induced Parkinsonism

Klawans, Harold L.; Bergen, Donna; Bruyn, G.W.

doi:10.1159/000102857

Cited by 53 publications

(22 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Most notably, our cases recovered gradually from severe EPS several months after cessation or reduction of neuroleptics, in agreement with some early case reports showing sustained but reversible parkinsonism [9]. Klawans et al [6] described initially such neurotoxic effects of neuroleptics as ''prolonged'' drug-induced parkinsonism. However, the clinical picture of the cases reported here is apparently different from those reported by Klawans et al [6].…”

Section: Discussionsupporting

confidence: 91%

“…Klawans et al [6] described initially such neurotoxic effects of neuroleptics as ''prolonged'' drug-induced parkinsonism. However, the clinical picture of the cases reported here is apparently different from those reported by Klawans et al [6]. The clinical picture described by Klawans et al showed a simple sustained parkinsonism, but our cases showed a wide spectrum of EPS (e.g., severe rigidity in limited body areas and with coexistence of oral dyskinesia).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Two cases of neuroleptic-induced prolonged extrapyramidal symptoms

Nishikawa

Hayashi

Nishioka

et al. 2005

International Journal of Psychiatry in Clinical Practice

View full text Add to dashboard Cite

Neuroleptic-induced extrapyramidal symptoms (EPS) are generally categorized as acute, withdrawal and tardive EPS. Here, we report two cases of a unique late-onset, long-lasting EPS (e.g., prolonged EPS); in those cases, EPS appeared a few months following initiation of haloperidol and lasted for a few months after significant reduction or complete withdrawal of neuroleptics. Case 1, a 41-year-old female, began to exhibit EPS such as bradykinesia, rigidity and parkinsonian gait 4 months after the haloperidol treatment. Her rigidity was ameliorated by a reduction of haloperidol; however, reduction of neuroleptics made it difficult for her to maintain a seated posture because of an imbalance of muscle tonus. Her EPS continued for 9 months even after haloperidol was switched to very low doses of thioridazine (10 mg/day). Case 2 is a 42-year-old female. She exhibited EPS including dysphagia and a difficulty in opening her mouth 3 months after the haloperidol treatment began. Her EPS lasted for 45 days, even after complete withdrawal of neuroleptics. The EPS observed in these two cases occurred even after prolactin levels became normal. "Prolonged EPS" is a unique subclass of neuroleptic-induced reversible EPS that might involve the coexistence of hypo- and hyper-dopaminergic transmission, especially in patients who show very low tolerance to neuroleptics.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Two cases of neuroleptic-induced prolonged extrapyramidal symptoms

Nishikawa

Hayashi

Nishioka

et al. 2005

International Journal of Psychiatry in Clinical Practice

View full text Add to dashboard Cite

show abstract

“…However, usually it takes weeks to many months before drug-induced parkinsonism remits after the discontinuation of neuroleptics. 26 Indeed, drug-induced parkinsonism usually improves slowly over time with reduction or cessation of the offending drug. 27 Recently, Mirsattari et al described six patients with HIV infection and parkinsonism in whom the interruption of neuroleptics produced complete recovery in only one patient (2 months later) and partial or no response in others.…”

Section: Discussionmentioning

confidence: 99%

Pilot study with clozapine in patients with HIV-associated psychosis and drug-induced parkinsonism

Lera

Zirulnik

1999

Mov. Disord.

View full text Add to dashboard Cite

Clozapine (CZP) is an atypical antipsychotic drug that does not appear to block striatal dopamine receptors. In six patients who met the criteria of HIV‐associated psychosis and who had previously developed moderate parkinsonism as a result of the use of typical neuroleptic agents, CZP was added in an open, rising dose study. Subjects were evaluated at baseline after at least 7 days without neuroleptic drugs and then monthly for 3 months of the experimental treatment using three rating scales: Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), and motor examination of the Unified Parkinson's Disease Rating Scale (UPDRS). A significant reduction in psychopathology as represented in the BPRS total score (54.2 at baseline versus 23.9 at month 3) and CGI (2 and 8, respectively) was obtained with a mean CZP dose of 27.08 mg/day. Parkinsonism also improved by an average of 76.5% at the end of the study. One patient did not complete the study as a result of a progressive decrease in leukocyte count while on CZP. These preliminary results suggest that the pharmacologic properties of CZP may be of value in the management of HIV‐psychotic patients.

show abstract

“…[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

View full text Add to dashboard Cite

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

show abstract

Prolonged Drug-Induced Parkinsonism

Cited by 53 publications

References 9 publications

Two cases of neuroleptic-induced prolonged extrapyramidal symptoms

Two cases of neuroleptic-induced prolonged extrapyramidal symptoms

Pilot study with clozapine in patients with HIV-associated psychosis and drug-induced parkinsonism

Drug-induced parkinsonism: diagnosis and management

Contact Info

Product

Resources

About