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Drug-induced parkinsonism typically encompasses only the motor features. PD is typically accompanied by various non-motor symptoms, some of which, such as depression, sleep disorders, loss of smell and constipation, appear earlier in the disease course than the motor symptoms of PD.Drug-induced parkinsonism often affects both sides of the body equally, whereas PD is virtually always asymmetric, affecting one side of the body more than the other.There are key differences to note between parkinsonism from PD and parkinsonism as a side effect of medication. The differences of PD vs drug-induced parkinsonism The prescription medication that blocked the dopamine receptor, was the proverbial “straw that broke the camel’s back”, inducing the full-fledged symptoms of dopamine depletion and revealing that the person did in fact have PD. In this scenario, that person most likely had dopamine depletion in the brain (prior to going on the medication) which had not yet manifested as a clinical symptom. The patient remains off the medication with continuing symptoms, and eventually is given a diagnosis of PD. The prescribing physician may stop the new medication, but the parkinsonism does not resolve. Sometimes, a person without a diagnosis of PD is prescribed a medication which leads to a side effect of drug-induced parkinsonism.
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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. APDA has created a list of Medications to be Avoided or Used With Caution in Parkinson’s Disease. 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. The connection between PD and drug-induced parkinsonism This is a tricky clinical situation, and one that typically requires the psychiatrist and neurologist to work together to optimize the circumstances. In these difficult situations, some amount of parkinsonism might be tolerated in order to maximize the person’s mental health. For example, some people with bipolar disorder or schizophrenia have tried multiple medications to control their mental health issues and the one that works best also causes parkinsonism. The primary treatment for this type of parkinsonism is weaning off of the offending medication, if possible.įor some people, it is not possible to stop the problematic medication. Anti-psychotics and anti-nausea treatments make up the bulk of the problematic medications, although there are other medications that can also cause parkinsonism. Reviewing a patient’s medications is therefore a critical step for a neurologist when seeing someone with parkinsonism. This set of symptoms can be caused by PD, but also can occur as a side effect of certain prescription medications (that have nothing to do with PD).Ī number of medications can cause parkinsonism because they block the dopamine receptor and thereby mimic the symptoms of PD that are caused by loss of dopamine neurons in the brain. Parkinsonism is not technically a diagnosis, but rather a set of symptoms including slowness, stiffness, rest tremor, and problems with walking and balance. But there is one other common condition that induces the symptoms of PD, including a rest tremor, which must be considered every time PD is being considered as a diagnosis, and that is drug-induced parkinsonism. Rest tremor (which is a tremor that goes away with movement, but often returns when the limb is at rest) for example, is seen in virtually no other illness and can therefore be very important in diagnosing PD. The motor features of PD are often (but not always) very easy to see via a neurologic exam in a doctor’s office. Common symptoms of drug-induced parkinsonism So today, I will address drug-induced parkinsonism. A frequent topic that I am asked about is symptoms of Parkinson’s disease (PD) that are caused by medications. I’m so thankful to those of you who submit potential topics for my blog as it helps me understand what you would like to know more about.