title: Neuroleptic-induced Parkinsonism: Clinicopathological study.
abstract: BACKGROUND
  Drug-induced parkinsonism is a well-known complication of several different drugs--the most common being neuroleptic-induced parkinsonism. However, very few autopsies have been reported in such cases.
  
  
  METHODS
  Patients assessed at Movement Disorders Clinic Saskatchewan are offered brain autopsy. Detailed clinical records are kept.
  
  
  RESULTS
  Brains were obtained from 7 drug-induced parkinsonism patients with parkinsonian symptom onset coinciding with use of drugs known to produce parkinsonism. Six were on antipsychotics and 1 was on metoclopramide. Three cases were treated with levodopa for parkinsonism. In two cases, parkinsonian features reversed after stopping the offending agent. Both had autopsy evidence of preclinical PD. In 4 of the remaining 5, dopamine-blocking drugs were continued until death. In 4 of those 5, brain histology revealed no cause for the parkinsonism, but 1 had mild SN neuronal loss without Lewy bodies.
  
  
  CONCLUSIONS
  This study shows that reversal of parkinsonism after discontinuing offending drugs does not indicate absence of underlying pathology. Neuroleptics can unmask preclinical PD in patients with insufficient SN damage for the disease to manifest clinically. Though the mechanism of sustained parkinsonian features after discontinuing neuroleptics remains to be established, it is unlikely that dopamine receptor block leads to retrograde SN neuronal degeneration. Furthermore, L-dopa does not appear to be toxic to SN.
authors.affiliation: Saskatchewan Movement Disorders Program, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
authors.forename: Umar A
authors.initials: UA
authors.lastname: Shuaib
authors.affiliation: Division of Neurology, Saskatchewan Movement Disorders Program, University of Saskatchewan, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Rajput
authors.affiliation: Neuropathology, Department of Pathology, University of Saskatchewan, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Robinson
authors.affiliation: Division of Neurology, Saskatchewan Movement Disorders Program, University of Saskatchewan, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Rajput
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015259:Dopamine Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use; D016631:Lewy Bodies / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010302:Parkinson Disease, Secondary / Q000139:chemically induced / Q000473:pathology*; D013378:Substantia Nigra / Q000473:pathology*
chemical_list: D014150:Antipsychotic Agents; D015259:Dopamine Agents; D007980:Levodopa
keywords: drug induced; neuroleptic-induced; parkinsonism; pathology; substantia nigra