What Is Drug Induced Parkinson’s Disease

What Is Vascular Parkinsonism

Vascular Parkinsonism is a condition in which areas of the brain that control movement have been damaged due to small strokes. This results in symptoms like muscle stiffness and balance problems, which are also common in PD.

Vascular Parkinsonism is one of several types of Parkinsonism. Parkinsonisms are conditions that cause symptoms that are similar to PD but are not PD. The other main types are:

• normal pressure hydrocephalus

The vascular damage is often the result of small strokes that have occurred over a period of several years. PD, on the other hand, is caused by the impairment or death of brain cells that produce the chemical dopamine, which plays a critical role in regulating body movement, among other important functions.

Standard Protocol Approvals Registrations And Patient Consents

The Institutional Review Board of Severance Hospital approved this retrospective study and waived the need for informed consent as part of approval since we used retrospective de-identified data collected during outpatient visits. In addition, all methods were performed in accordance with the approved guidelines.

Incidence Of Pd And Dip

The mean age of incident patients with PD increased from 70.89 in 2012 to 71.33 in 2015, while the mean age of incident patients with DIP decreased from 48.78 in 2012 to 47.39 in 2015. DIP incident patients were younger than PD incident patients. However, when excluding antipsychotics as a sensitivity analysis, the mean age of incident patients with DIP was 64.31 in 2012 and 63.58 in 2015.

The average incidence of PD between 2012 and 2015 was 34.97 per 100,000 person-years, while the average age-standardized incidence of PD according to the WHO 20002025 and US 2000 standard population between 2012 and 2015 was 23.49 and 35.79 per 100,000 person-years, respectively. In contrast, the average incidence of DIP between 2012 and 2015 was 8.69 per 100,000 person-years, and the average age-standardized incidence of DIP according to the WHO 20002025 and US 2000 standard population between 2012 and 2015 was 7.13 and 7.98 per 100,000 person-years, respectively.

A higher average incidence of PD between 2012 and 2015 was observed in both male and females in the older age groups. The peak incidence was reached in the age group of over-80years old, with a higher incidence in males. In contrast, the average incidence of DIP between 2012 and 2015 showed a bimodal distribution in the age group of 4549 and 7579years, with a higher incidence in females .

Fig. 3

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How Is Drug Induced Parkinsonism Different From Parkinsons Disease

Is it possible to distinguish drug induced parkinsonism from Parkinsons Disease on clinical grounds?

Drugs are one of the most common causes of parkinsonism in the general population.

Drugs that block postsynaptic dopamine receptors and/or deplete presynaptic dopamine may cause parkinsonism.

Clinical studies indicate that drug-induced parkinsonism is indistinguishable from Parkinsons Disease.

Discontinuation of the offending drug promotes remission of the syndrome in most cases, although sometimes the parkinsonism persists.

Such patients may have subclinical Parkinsons Disease and require dopaminergic therapy. DaTSCAN is a useful tool to differentiate between Parkinsons Disease and drug-induced parkinsonism.

Drugs Associated With Parkinsonism And Other Abnormal Involuntary Movements

There are numerous drugs and drug classes that are associated with the development of parkinsonism and other abnormal involuntary movements. Drug-induced parkinsonism is often not recognised, especially in the non-psychiatric patient , The side effect often develops within 1 month of the start of treatment, with 60% of patients developing it by this time point and 90% within 3 months .The potency of antipsychotics is defined by their ability to block the D2 receptors. Therefore, high-potency neuroleptics tend to have a greater propensity to cause extra-pyramidal side effects. However, some high-potency neuroleptics that also have anticholinergic properties are associated with fewer motor side effects. Atypical antipsychotics tend to have broader pharmacodynamic effects, and it is thought that their activity at 5HT2a receptors mediate efficacy with less need for blocking of the D2 receptors in the mesolimbic pathways and therefore in the substantia nigra.

The evidence surrounding iatrogenic dystonias is less well developed. Conventional neuroleptics are clearly implicated as are calcium channel blockers. Additionally, there are several case reports noting an association with olanzapine, carbamzaepine, lithium, imipramine, gabapentin and ziprasidone. Other dystonias are less clearly associated with iatrogenic causes.

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How Often Do Drugs Induce Parkinsons Disease

Before I begin I wish to state clearly: this is not aimed at blaming patients with Parkinsons disease for becoming ill. The aim of this blog post is to explore and review the extent to which drugs, both illegal and legal, induce Parkinsons disease. Officially this type of Parkinsons is known as drug-induced Parkinsons and the symptoms termed Parkinsonism instead of Parkinsons symptoms. The terminology is not the only variation between drug-induced and organic forms of Parkinsons disease. Drug-induced Parkinsonism is occasionally reversible with the aggressive treatment. In addition drug-induced Parkinsonism features symmetrical symptom manifestation. If both arms shake symmetrically and simultaneously drug-induced Parkinsons is the culprit. These two key differences set drug-induced Parkinsonism apart from organic Parkinsons disease.

Overall the chemicals and prescription drugs associated with Parkinsonism have diverse applications with the only common factor being dopamine. Most is known concerning the ability for anti-psychotic medications to cause Parkinsonism. While eliciting opposite behavioral effects, amphetamine and anti-psychotics both disrupt use of dopamine by the brain with enough potency to cause Parkinsonism. MPTP acts as a toxin that selectively destroys the dopamine system leaving the user with Parkinsonism.

The Connection Between Pd And Drug

In addition to potentially causing parkinsonism in the general population, these medications should definitely be avoided in people who have parkinsonism from other causes, such as PD. APDA has created a list of Medications to be Avoided or Used With Caution in Parkinsons Disease. It is important to note that there are anti-psychotics and anti-nausea medications which do not cause parkinsonism and can be used safely by people with PD.

Sometimes, a person without a diagnosis of PD is prescribed a medication which leads to a side effect of drug-induced parkinsonism. The prescribing physician may stop the new medication, but the parkinsonism does not resolve. The patient remains off the medication with continuing symptoms, and eventually is given a diagnosis of PD. In this scenario, that person most likely had dopamine depletion in the brain which had not yet manifested as a clinical symptom. The prescription medication that blocked the dopamine receptor, was the proverbial straw that broke the camels back, inducing the full-fledged symptoms of dopamine depletion and revealing that the person did in fact have PD.

The differences of PD vs drug-induced parkinsonism

There are key differences to note between parkinsonism from PD and parkinsonism as a side effect of medication.

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Asymmetry In Parkinsonism In Relation To Severity Of Psychopathology

The regression, controlled for predefined covariates, yielded both significant and non-significant coefficients between asymmetry in parkinsonism and the severity of psychopathology with a range of 0.373.74 , with a significant coefficient for the positive symptom scale .

Table 4. Multilevel mixed model results: regression coefficients of asymmetry with the severity of psychopathology a.

Dip Can Easily Be Misdiagnosed As Pd

Both DIP and PD have identical symptoms, which makes certain cases extremely hard to differentiate and can lead to DIP being misdiagnosed by PD. These symptoms can include some or all of the following: tremor, resting tremor, muscle stiffness, impaired speech, slow gait and movements, and problems with posture and balance. Collectively, these symptoms are known as parkinsonism. In some cases, these symptoms have also been called atypical Parkinsons disease, secondary parkinsonism, or Parkinsons plus. Of course parkinsonism can be caused by PD, but it can also occur as a result of DIP. The main difference between parkinsonism associated with DIP and PD is that parkinsonism associated with DIP generally comes on rapidly, while parkinsonism associated with PD tends to develop gradually.

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Be Your Own Health Advocate

Every drug carries risks.The Save Institute recommends avoiding prescriptions drugs except in matters of life and death. The dire, life-altering consequences of DIP are a striking example of why this recommendation is so important for maintaining your health.

Do your own research about the potential side effects of any drug, and always seek a natural remedy instead of a synthetic drug. In the case of osteoporosis and osteopenia, reversal is possible through a combination of diet, exercise and bone-healthy lifestyle choices.

Clinical Features Of Drug

• Course of Neurology, Department of Health Sciences, Tsukuba University of Technology, Japan.
• Akira TamaokaDeparment of Neurology, Graduate School of Comprehensive Human Science, University of Tsukuba, Japan.
• Norio OhkoshiCourse of Neurology, Department of Health Sciences, Tsukuba University of Technology, Japan.

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Some Cases Of Parkinsonism Can Be Reversed Others Cannot

In most cases, drug-induced parkinsonism can be reversed once the medication causing the problem is eliminated. However, it can take some time for an individual to return to normal. Depending on the medication and its effects, it can take anywhere from 4-18 months for DIP to resolve itself. In some cases, however, parkinsonism may continue even after the medication has been stopped for more than 18 months. This happens when an individual already has a dopamine deficit that was not caused by the medication. In these cases, that individual was already going to develop PD at some point, however DIP accelerated the process.

Dr. Kashouty, a diplomate of the American Board of Psychiatry and Neurology , practices general neurology with fellowship trained specialization in clinical neurophysiology. Dr. Kashouty finds the form and function of the nerves and muscles the most interesting part of neurology, which is what led him to specialize in neurophysiology with more emphasis on neuromuscular conditions. He treats all neurological diseases, but his main focus is to treat and manage headaches, movement disorders and neuromuscular diseases.

What Is Parkinsonism

Parkinsonism is a general term that refers to a group of neurological disorders that cause movement problems similar to those seen in Parkinsons disease such as tremors, slow movement and stiffness. Under the category of parkinsonism there are a number of disorders, some of which have yet to be clearly defined or named. Early in the disease process, it is often hard to know whether a person has idiopathic Parkinsons disease or a syndrome that mimics it. Parkinsonisms, also known as atypical Parkinsons disease or Parkinsons plus, represent about 10-15% of all diagnosed cases of parkinsonism. These syndromes tend to progress more rapidly than Parkinsons, present with additional symptoms such as early falling, dementia or hallucinations, and do not respond or respond only for a short time to levodopa therapy.

Following are descriptions of some of the most common Parkinsons plus disorders. It is important to remember that many people will not exhibit the cardinal symptoms necessary for a diagnosis of a specific disorder and will simply be labeled parkinsonism. For these people a definite diagnosis will only come if the family requests a brain autopsy at time of death.

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What Are The Causes

Drug-induced parkinsonism is caused by medications that reduce dopamine levels in the brain. Dopamine is a neurotransmitter that works to control bodily movements.

Dopamine is also part of the brains reward system. It helps you feel pleasure and enjoyment, and it supports your ability to learn and focus.

Medications that bind to and block dopamine receptors are called dopamine antagonists. These medications arent used to treat Parkinsons disease. Rather, theyre used to treat other conditions that might seriously impact your quality of life.

If your doctor has prescribed a medication that causes unwanted side effects, you may have options. You may also decide that the side effects are worth it if the medication effectively treats your condition.

Some medications that cause drug-induced parkinsonism include:

Tremors Can Have Different Causes

It can be challenging to determine the exact cause of tremor, particularly if you already have a neurological condition such as Parkinsons disease . Uncontrollable tremor is a symptom of PD especially if you are taking multiple medications.2 In fact, medications can exacerbate existing tremor or cause non-Parkinsons tremor.

Medication-induced tremor is dependent on a differential diagnosis based on a physical exam and complete medical history.2

Tremor is a recognized symptom of PD and classified as a resting tremor. It is generally moderated when taking standard PD dopaminergic medications. But Parkinsons is a persistent condition so PD tremor may never go away entirely. Its common knowledge that Parkinsons affects each person differently when, how, and where you experience tremor is unique to you. Parkinsons tremor is not symmetrical it disproportionately affects one side of your body.2

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Pros & Cons To Treating Mit

Your doctor can help you determine if the medication regimen is right for you. The doctor is able to evaluate if there are alternative drugs, formulations, or dose adjustments that can help to better manage your medical condition without the presence of tremor.

Some people can eliminate drugs that are inducing tremor. Yet there can be trade-offs between having side effects and benefitting from what could be life-saving treatment with immunosuppressant drugs to prevent transplant rejection.

Make sure to let your doctor know if you are experiencing tremor or other side effects from the medications you take, whether for Parkinsons or other conditions. Do not stop taking any medications without first discussing what you are experiencing with your medical team.

Dementia With Lewy Bodies

DLB is second only to Alzheimers as the most common cause of dementia in the elderly. It causes progressive intellectual and functional deterioration. In addition to the signs and symptoms of Parkinsons disease, people with DLB tend to have frequent changes in thinking ability, level of attention or alertness and visual hallucinations. They usually do not have a tremor or have only a slight tremor. The parkinsonian symptoms may or may not respond to levodopa.

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Correlation Analysis Between Rsfmri Values And Dat Uptake In Pd Patients

To define whether altered functional activities common to both PD and DIP patients compared to the control group were associated with dopaminergic depletion, we performed a correlation analysis between the rsfMRI values in the overlapping ROIs and SNBR in the striatal ROIs. We included only 59 PD patients who underwent DAT scans and MR scanning at an interval of 2 months or less in this analysis as DIP patients have normal DAT uptake in the striatum and as such, correlation results would not adequately reflect dopaminergic depletion in the brains of these patients.

What Are The Symptoms Of Vascular Parkinsonism

Most of the well-known symptoms of PD are also present in vascular Parkinsonism. With vascular Parkinsonism, muscle control challenges are more concentrated in the lower body, whereas with PD, they tend to affect the entire body.

While tremors are common in people with PD, it isnt a key symptom of vascular Parkinsonism. Some people with the vascular condition experience a resting tremor, but this usually occurs later in the course of disease.

The main symptoms of vascular Parkinsonism include:

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Exposure To Toxins Can Also Cause Parkinsonism

While drug-induced parkinsonism is primarily caused by certain medications, there are also cases that have been linked to extensive or long-term exposure to environmental toxins. When the body is regularly exposed to certain toxins, it causes oxidative stress or mitochondrial dysfunction, both of which can result in movement disorders. Toxins associated with causing parkinsonism include: pesticides/herbicides, MTTP, agent orange, certain solvents, manganese and other metals, and organic pollutants.

Not All Tremors Are Associated With Parkinsonism

Other than parkinsonism, some medications can also cause drug-induced tremors, which are not associated with parkinsonism. Drug-induced tremors can take the form of postural or action tremors, and they can accompany other PD-like symptoms. Postural tremors occur when the body part is held against gravity, such as when holding something away from the body. An action tremor occurs when the affected body part is moving. Drug-induced tremors also tend to occur on both sides of the body, whereas tremors associated with PD tend to affect one side more than the other. Although similar to DIP, drug-induced tremors differ in that they are not resting tremors. Resting tremors occur only when a limb is at rest and can affect the fingers, hands, feet, or jaw. Resting tremors are also only associated with PD or DIP.

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Which Drugs Can Cause Parkinsonism

Typical antipsychotic , are the most common causative agents of drug-induced parkinsonism. It has been seen that certain atypical antipsychotics, which are thought to be free from extrapyramidal symptoms, can also induce Parkinsonism. Besides the gastrointestinal motility drugs, antipsychotics, antiepileptic drugs, and calcium channel blockers can lead to drug-induced Parkinsonism.

The most common drugs that cause Parkinsonism are listed below:

• Antiemetics 3

Parkinsonism Falls And Fracture Risk

All forms of parkinsonism, both PD and DIP, have implications for bone health. A 2014 meta-analysis on PD and fracture risk concludes that PD increases the risk of fracture.4

Given that the symptoms of parkinsonism affect balance, motor skills, gait, and the bodys ability to control movement, it is no surprise that people with PD are more likely to experience a fall than people without PD. Here is an excerpt from a 2016 study comparing the incidence of falls and fracture in PD patients:

It is estimated that 60.5% of patients with PD experience at least one fall and 39% have recurrent falls. The high frequency of falls consequently contributes to the increased risk for fractures in PD patients, which has been estimated to be approximately two times the risk in healthy controls. It has been estimated that 76% of falls in PD patients require health care services and 33% result in fractures. Falls and fractures may result in a series of unfavorable outcomes, such as disabilities and death. Furthermore, among PD patients with fractures, the mortality rate is approximately 10.6%.5

All too often, doctors prescribe these drugs without appropriate consideration of this risk. This excerpt from a study on DIP clarifies the danger of accepting a prescription of an unnecessary or inappropriate prescription drug:

Shockingly, the drugs that cause DIP are still being prescribed. This yet one more example further proving that the FDAs drug approval process is useless.

Synopsis

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