[Drug-induced parkinson syndromes].
Parkinsonism is defined by the association of akinesia with one of the following symptoms: extrapyramidal rigidity, tremor at rest, or postural instability. A drug-induced aetiology must always be suspected when parkinsonian symptoms appear, or increase in a patient receiving drug treatment. Indeed drug-induced is the more frequent aetiology of secondary parkinsonism. The main treatments involved are antipsychotic and other neuroleptic drugs (accounting for up to two-thirds of drug-induced parkinsonism), and calcium-channel entry blockers. The risk associated with antipsychotics is often dose dependent and related to dopamine D2 striatal receptor occupancy induced by the antipsychotic drug. This risk is inferior for the second generation antipsychotics. The other treatments more rarely involved are antidepressants (tricyclic and selective serotonin reuptake inhibitors), lithium, valproic acid, and others. The main criterium for imputability is chronological, regression of symptoms being observed in 40-74% of cases, after a mean delay of 3 months from cessation of treatment. However, 15% of cases persist after drug withdrawal, leading to a diagnosis of underlying idiopathic Parkinson's disease.
Nguyen
Nhan
N
CPCET et Pharmacologie Clinique, Institut de Neurosciences Physiologiques et Cognitives, Faculté de Médecine, FRE 2109 CNRS-Université de la Méditerranée, Assistance Publique Hôpitaux de Marseille, Hôpital de la Timone, Marseille, France.
Pradel
Vincent
V
Micallef
Joëlle
J
Montastruc
Jean-Louis
JL
Blin
Olivier
O
D000927:Anticonvulsants / Q000009:adverse effects; D000928:Antidepressive Agents / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000009:adverse effects; D002121:Calcium Channel Blockers / Q000009:adverse effects; D006801:Humans; D008094:Lithium / Q000009:adverse effects; D010302:Parkinson Disease, Secondary / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects; D014635:Valproic Acid / Q000009:adverse effects
D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D002121:Calcium Channel Blockers; D008094:Lithium; D017367:Selective Serotonin Reuptake Inhibitors; D014635:Valproic Acid