Parkinsonism
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Synonyms and keywords: Parkinson’s syndrome; atypical Parkinson’s; secondary Parkinson’s
Overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Parkinsonism is a neurological syndrome characterized by tremor, hypokinesia, rigidity, and postural instability.[1] The underlying causes of parkinsonism are numerous, and diagnosis can be complex.[2] While the neurodegenerative condition Parkinson’s disease (PD) is the most common cause of parkinsonism, a wide-range of other etiologies can lead to a similar set of symptoms, including some toxins, a few metabolic diseases, and a handful of non-PD neurological conditions.[3] Its most common cause is as a side effect of medications, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupenthixol and zuclopenthixol) and butyrophenones (such as haloperidol (Haldol)), piperazines (such as ziprasidone), and rarely, antidepressants.
References
- ↑ Aminoff MJ, Greenberg DA, Simon RP (2005). Clinical Neurology (6th ed. ed.). Lange: McGraw-Hill Medical. pp. 241&ndash, 5. ISBN 0071423605.
- ↑ Tuite PJ, Krawczewski K (2007). “Parkinsonism: a review-of-systems approach to diagnosis”. Seminars in neurology. 27 (2): 113–22. doi:10.1055/s-2007-971174. PMID 17390256.
- ↑ Christine CW, Aminoff MJ (2004). “Clinical differentiation of parkinsonian syndromes: prognostic and therapeutic relevance”. Am. J. Med. 117 (6): 412–9. doi:10.1016/j.amjmed.2004.03.032. PMID 15380498.
Historical Perspective
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References
Pathophysiology
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References
Causes
Causes by Organ System
| Cardiovascular | No underlying causes |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Cytarabine, Fluphenazine, Perphenazine, Thiothixene, Thioridazine hydrochloride |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal/Electrolyte | No underlying causes |
| Rheumatology/Immunology/Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Causes in Alphabetical Order
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References
Differentiating Parkinsonism from other Diseases
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Differentiating Parkinsonism from other Diseases
If PD has been excluded, the differential diagnosis or list of potential causes for this syndrome includes:
- AIDS can sometimes lead to the symptoms of Parkinson’s disease, due to commonly causing dopaminergic dysfunction.[1]
- Corticobasal degeneration[2]
- Creutzfeldt-Jakob disease[3]
- Diffuse Lewy body disease[2]
- Drug-induced parkinsonism (due to drugs such as antipsychotics, metoclopramide, MPTP[4])[2]
- Encephalitis lethargica[2]
- Multiple system atrophy[5]
- Pantothenate kinase-associated neurodegeneration (Hallervorden-Spatz syndrome)[6]
- Progressive supranuclear palsy[2]
- Toxicity due to substances such as carbon monoxide,[7] carbon disulfide,[7] manganese,[7]paraquat,[8] hexane,rotenone, and toluene.
- Vascular parkinsonism[9]
- Wilson’s disease is a genetic disorder in which there is an abnormal accumulation of copper. The excess copper can lead to the formation of a copper-dopamine complex, which leads to the oxidation of dopamine to aminochrome.[10]
- Paraneoplastic syndrome. Neurological symptoms caused by antibodies associated with various cancers.
References
- ↑ Tse W, Cersosimo MG, Gracies JM; et al. (2004). “Movement disorders and AIDS: a review”. Parkinsonism Relat. Disord. 10 (6): 323–34. doi:10.1016/j.parkreldis.2004.03.001. PMID 15261874.
- ↑ 2.0 2.1 2.2 2.3 2.4 Invalid
<ref>tag; no text was provided for refs namedAminoff_2005 - ↑ Maltête D, Guyant-Maréchal L, Mihout B, Hannequin D (2006). “Movement disorders and Creutzfeldt-Jakob disease: a review”. Parkinsonism Relat. Disord. 12 (2): 65–71. doi:10.1016/j.parkreldis.2005.10.004. PMID 16364674.
- ↑ Watanabe Y, Himeda T, Araki T (2005). “Mechanisms of MPTP toxicity and their implications for therapy of Parkinson’s disease” (PDF). Med. Sci. Monit. 11 (1): RA17–23. PMID 15614202.
- ↑ Wenning GK, Geser F (2003). “Multiple system atrophy”. Rev. Neurol. (Paris). 159 (5 Pt 2): 3S31–8. PMID 12773886.
- ↑ Uc EY, Rodnitzky RL (2003). “Childhood dystonia”. Seminars in pediatric neurology. 10 (1): 52–61. doi:10.1016/S1071-9091(02)00010-4. PMID 12785748.
- ↑ 7.0 7.1 7.2 DeLong MR, Juncos JL (2004). Parkinson’s Disease and Other Movement Disorders. In: Harrison’s Principles of Internal Medicine (16th ed. ed.). McGraw-Hill Professional. pp. p. 2414. ISBN 0-07-140235-7.
- ↑ Dinis-Oliveira RJ, Remião F, Carmo H; et al. (2006). “Paraquat exposure as an etiological factor of Parkinson’s disease”. Neurotoxicology. 27 (6): 1110–22. doi:10.1016/j.neuro.2006.05.012. PMID 16815551.
- ↑ Thanvi B, Lo N, Robinson T (2005). “Vascular Parkinsonism–an important cause of parkinsonism in older people” (PDF). Age and ageing. 34 (2): 114–9. doi:10.1093/ageing/afi025. PMID 15713855.
- ↑ Członkowska A, Tarnacka B, Möller JC; et al. (2007). “Unified Wilson’s Disease Rating Scale – a proposal for the neurological scoring of Wilson’s disease patients”. Neurol. Neurochir. Pol. 41 (1): 1–12. PMID 17330175.
Epidemiology and Demographics
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Risk Factors
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Risk Factors
- Infections such as encephalitis, meningitis
- Stroke
- Brain tumor
- Degenerative disorders: Corticobasal degeneration, dementia, diffuse Lewy body disease, multiple system atrophy, progressive supranuclear palsy
- Toxins: Manganese, carbon monoxide, and methanol
- Medications: Antipsychotics, metoclopramide, phenothiazine, overdose of anesthesia drugs
References
Natural History, Complications and Prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Complications
- Difficulty performing daily activities
- Difficulty swallowing (eating)
- Disability (varying degrees)
- Injuries from falls
- Side effects of medications
Side effects from loss of strength (debilitation):
- Aspiration
- Deep vein thrombosis
- Malnutrition
Prognosis
Prognosis of Parkinsonism depends on the underlying cause. Outcomes of Parkinsonism caused by brain tumors are poorer than other causes. If the disorder is caused by medications, it may be reversible.
References
Diagnosis
Diagnosis
History and Symptoms | Physical Examination |Laboratory Findings | CT | MRI | Other Imaging Findings |Other Diagnostic Studies
Treatment
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
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