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Parkinson’s is a neurological syndrome characterized by pillow tremor , uncontrollable movements , muscle rigidness , slurred words , postural instability , difficulty maintain balance andunsteady gait.1Very often , the terms ‘ Parkinsonism ’ and‘Parkinson ’s disease ’ are confused with each other . It should be noted that clinically these terms have unlike meaning .
Parkinsonism is a generic name given to a mathematical group of characteristic that can be seen in multiple neurological disorder let in Parkinson ’s disease . In other Word , Parkinsonism is a feature pick up in Parkinson ’s disease . Besides Parkinson ’s disease , Parkinsonism can be because of various other medical problems such as brain damage , reformist supranuclear palsy , corticobasal degeneration , multiple organisation wasting , dementedness , cephalitis , HIV / AIDS , meningitis , stroke , Wilson ’s diseaseand induced by certain drug .
What is Drug-Induced Parkinsonism?
The form of Parkinsonism that develop after being treated with particular medications is cognise as drug - induce Parkinsonism.2It is the one of the most common lawsuit of Parkinsonism after Parkinson ’s disease . Any drug that which leads to closure of the action of dopamine or reduces the computer storage of dopamine can cause Parkinsonism . These include drugs that are commonly used for treatingschizophrenia ; dementedness ; other drugs used for treatment of eminent profligate pressure ; medicament for dizziness , sickness and digestive issue ; and certain medications used for treatment of angina pectoris , panic attacks , migraine , maniacdepressionand abnormal heart rhythm .
Characteristic of Drug-Induced Parkinsonism
Drug - rush Parkinsonism impact both side of the body in a harmonious manner . It is less likely to be assort with earth tremor ; however in certain cases it is the symptom are meet asymmetrically associated with a tremor . The earlier features let in akinesia with loss of arm . Other common signs admit Bradykinesia which cause going of facial manifestation , slow movement and speech issues .
Which Drugs Can Cause Parkinsonism?
Typical antipsychotic ( neuroleptics ) , are the most common causative federal agent of drug - induced parkinsonism . It has been seen that sealed atypical antipsychotics , which are thought to be free from extrapyramidal symptoms , can also induce Parkinsonism . Besides the GI ( GI ) motion drug , major tranquillizer , antiepileptic drugs , and atomic number 20 channel blocker ( CCBs ) can lead to drug - induced Parkinsonism .
The most vernacular drug that cause Parkinsonism are listed below :
Epidemiology of Drug-Induced Parkinsonism
A population - ground study and a community of interests base resume give away that drug - induced Parkinsonism has a prevalence rate of 2.7 % . It has been seen that 7 to 10 % of Parkinsonism is triggered by drugs . Age is a very of import risk divisor for drug - induced Parkinsonism , as the dopamine storage and nigral cells deplete with increased age . It has been noticed that this shape is more unwashed among females than in male , as estrogen supresses the expression of dopamine receptor . genetical make - up also plays a major character in development of drug - stimulate Parkinsonism .
How to Differentiate Between Drug Induced Parkinsonism and Parkinsonism Disease?
Drug - cause Parkinsonism can mime feature of Parkinsonism disease and other parkinsonian syndromes . However , there are certain clinical lineament that help in differentiating drug - induced Parkinsonism from Parkinsonism disease . Drug - hasten Parkinsonism has a sudden and acute onset of symptom which can be directly correlate with debut of a new drug in the scheme . Drug related Parkinsonism represent itself clinically within a few days to 3 months after starting a new drug . Parkinson ’s disease is usually characterise by asymmetric signs and symptoms , even at in advance stages . Drug - induced Parkinsonism usually confront itself symmetrically . freeze , which is more common in Parkinson ’s disease , is a rare occurrence in drug - induced Parkinsonism . Incidence of eternal rest tremor is more plain in drug - induced Parkinsonism than in Parkinson ’s disease . study have also experience that drug - induced Parkinsonism is more vulgar in females , whereas Parkinson ’s disease is more mutual in males . Drug - induced Parkinsonism respond to anticholinergic drugs , and Parkinson ’s disease responds to Levadopa .
Diagnosis of Drug-induced Parkinsonism
foremost , it is important to obtain a patient ’s elaborate medicament history . It is also important to remark the dosage and the rate of dose escalation been done recently . Other possible risk factors include history of dementia , HIV contagion , increase age , distaff grammatical gender and familial Parkinson ’s disease . Dopamine conveyer imaging can flirt a full of life role in sleuthing of drug - induce Parkinsonism .
Treatment of Drug-induced Parkinsonism
Drug - get Parkinsonism is a two-sided unconscious process . Treatment of drug - stimulate Parkinsonism involves careful identification of the causative drug followed by coitus interruptus of the offend medication . In most of the cases , the symptoms lessen within a workweek . In a belittled number of cases , the symptoms persist for a year or even more . In severe case , one can weigh treatment with anti - cholinergic medicament or Amantadine . occasional rating and re - judgment of symptoms should be carry out by aesculapian professionals even after discontinue the causative factor .
Preventive measure include awareness of the condition and associated symptoms , avoidance of the unneeded dictate medications and , if needed , one should prescribe lowest dose of causative drugs and avoid care of these drugs for sustain time period of time .
Drug - induced Parkinsonism is the vulgar cause of Parkinsonism and it is very often unrecognized or misdiagnosed as Parkinson ’s disease . The symptom can limit functionality and can last for prolonged periods of fourth dimension even after discontinuing the causative drug . Besides identifications of the wound drug , Dopamine Transporter ( DaT ) imaging may aid in accurate diagnosing of drug - induced Parkinsonism and it may also help in identification of the clinical characteristic and estimating the medical prognosis of the stipulation .
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