Neurodegenerative disorders | Other conditions |
---|---|
Parkinson’s disease | Vascular parkinsonism |
Progressive Supranuclear Palsy | Functional neurological disorder |
Multisystem Atrophy | Hyperthyroidism |
Corticobasal Syndrome | Benzodiazepine withdrawal |
Dementia with Lewy bodies | Infective and autoimmune encephalitis |
Feature | Parkinson’s Disease | Drug Induced Parkinsonism (DIP) |
---|---|---|
Sixth decade (but 20% are <50 years old) | Variable | |
More common in males | Uncertain | |
Chronic | Acute or subacute | |
Unilateral or asymmetric | Bilateral and symmetric | |
Absent | Present | |
Present | Present | |
Rest tremor occurs in 70% | Usually absent or a postural tremor | |
Progressive and may be marked | Usually mild | |
Good | Poor | |
Slight non-sustained improvement then progressive parkinsonism | Good with complete reversal of parkinsonism | |
Abnormal: Reduced uptake of pre-synaptic markers | Normal |
• | No previous history of parkinsonism before the prescription of the offending drug. |
• | Review medical history including past and present medications, assessing for potentiation, polypharmacy and potential drug interactions. |
• | Consider possible exposure to toxins or recreational drugs. |
• | Individuals with AIDS have an increased risk of DIP due to loss of neuronal cell bodies. |
• | Consider the individual’s age as Parkinson’s disease is less likely in individuals younger than 50 years. |
• | Review falls in combination with psychotropic administration as medications can lower blood pressure and increase the risk of falls in confused or at-risk patients. |
• | Review the timeframes associated with the onset of symptoms (usually acute or subacute with DIP). DIP has a temporal relationship with new medications and can occur within days of commencing a new drug, although in some cases it may be months prior to the onset of symptoms. |
• | Assess for signs and symptoms that are inconsistent with DIP including unilateral symptoms, significant axial impairment, freezing gait, hyposmia, or tremor. |
• | DIP is generally characterised as bilateral and symmetric parkinsonism. |
• | Response to levodopa is limited in DIP, yet diagnostically useful in Parkinson’s disease. |
• | Consider DaT scan, single proton emission computerized tomography (SPECT) particularly in cases where symptoms have not resolved within six months of ceasing offending drugs. |
• | Consider a comorbid or alternative diagnosis. |
Typical Antipsychotics | Chlorpromazine, Prochlorperazine, Promethazine, Fluphenazine, Haloperidol, Primozide, Sulpiride |
Atypical Antipsychotics | Olanzapine, Risperidone, Ziprasidone, Aripiparazole, Clozapine, Quetiapine |
Anti-emetics | Metoclopramide, Domperidone, Itopride |
Dopamine Depleters | Reserpine, Tetrabenazine |
Calcium-Channel Blockers | Flunarizine, Cinnarizine |
Mood Stabilizers | Lithium Carbonate |
Antiepileptics | Valproic acid, Phenytoin, Levetiracetam |
Anti-hypertensives | Diltiazem |
Antidepressants | Paroxetine, Sertraline, Fluoxetine |
Antiarrhythmics | Amiodarone, Procaine |
Statins | Lovastatin |
Immunosuppressants | Ciclosporin, Tacrolimus |
Antivirals | Acyclovir, Vidarabine |
Antibacterials | Sulfamethoxazole, Trimethoprim |
Antifungals | Amphotericin B |