Drug induced Parkinsonism is quite common in certain pool of patients especially when these patients are on neuroleptics or antipsychotic drugs, more commonly the older generation neuroleptics like chlorpromazine, carnase, risperidol. All these older generation neuroleptics or even the new generation neuroleptics can cause Parkinsonism. These patients s are on certain neuroleptics for certain psychiatric disorders for long time and the develop Parkinsonism, say if it is like masking the face, decreased volume of speech, slowness of movement in the limbs , slowness in the gait, which looks very closely similar to the atypical Parkinson’s disease, but there are certain differences between these two. Apart from having these Parkinsonian features, they have orofacial dyskinesias. They have tardive dystonia. There will be repeated movements of the tongue. There can be twisting of the face, rapid blinking of the eyes. So these are dystonic features which are associated commonly with this type of medications used in this type of psychiatric disorders. So there can be a combination of both hyperkinetic movements like dystonic movements or dyskinetic movements in the face. Along with that slowness of movements, which you don’t come across in a typical Parkinson’s disease.so this sis how you differentiate. Moreover parkinsonism is more symmetrical. That means there will be no difference between right or left. The axial muscles will be affected more commonly. There can be sometimes retropulsion. They can have falls more commonly backwards or bending of the body more backwards. These are commonly seen with drug induced Parkinsonism. Common neuroleptic medications too cause Parkinsonism. There are other class of drugs that cause Parkinsonism. Oflate the levosulpiride, which is used for motility disorders. The gastroenterologist uses this very commonly in combination with proton pump inhibitors, either pantoprazole or esomeprazole. This drug can cause rapid onset Parkinsonism. We have to be very careful when we use levosulpiride in elderly people. We have come across such patients and also drooling of saliva, change in behaviour, change in conscious level. So we have to be careful when we are using levosulpiride in elderly people. The other drugs with neurologists use is sodium valproate for epilepsies and it is also used by psychiatrists for bipolar disorder. So sodium valproate can also cause solely progressive Parkinsonism. You need to keep a watch when someone has developed a recent onset Parkinsonism, rapidly slightly faster than usual. So you need to keep a watch on these drugs which can cause Parkinsonism like features.

свернуть