Susceptibility to neuroleptic-induced parkinsonism--age and increased substantia nigra echogenicity as putative risk factors.
OBJECTIVE
Patients treated by neuroleptics often develop neuroleptic-induced parkinsonism (NIP) to a varying extent. The reasons for this are discussed controversially in the literature. Previous transcranial sonography (TCS) findings of the substantia nigra (SN) in patients with idiopathic Parkinson's disease suggest a correlation of echogenicity with nigrostriatal dysfunction.


METHODS
One hundred psychiatric patients receiving neuroleptics were included. They underwent clinical examination for NIP (Simpson and Angus-scale) and, independently, TCS of the SN. History of smoking habits and medication were taken from the patient's chart.


RESULTS
We found a significant positive association of the prevalence of NIP with age (P < 0.01) and the echogenic area of the SN (P < 0.05). Neither type nor dosage of the neuroleptics was found to have any significant impact on the occurrence of NIP. Smokers displayed lower prevalence of NIP (P < 0.05) and lower EPS scores (P < 0.01).


CONCLUSIONS
These findings suggest that age and increased size of SN echogenicity are possible risk factors for NIP. In contrast, smoking seems to have a certain protecting effect.
Jabs
Burkhard Emanuel
BE
Department of Psychiatry, Julius-Maximilians-University, Füchsleinstrasse 15, 97080 Würzburg, Germany. burkhard.jabs@mail.uni-wuerzburg.de
Bartsch
Andreas Joachim
AJ
Pfuhlmann
Bruno
B
D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003342:Corpus Striatum / Q000000981:diagnostic imaging / Q000187:drug effects; D004453:Echoencephalography; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000000981:diagnostic imaging / Q000187:drug effects; D009460:Neurologic Examination / Q000187:drug effects; D010302:Parkinson Disease, Secondary / Q000139:chemically induced* / Q000175:diagnosis; D011618:Psychotic Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012307:Risk Factors; D012559:Schizophrenia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012907:Smoking; D013378:Substantia Nigra / Q000000981:diagnostic imaging / Q000187:drug effects
D014150:Antipsychotic Agents