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Parkinsonism

Summary

Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia (slowed movements), rigidity, and postural instability.[1][2] Both hypokinetic (bradykinesia and akinesia) as well as hyperkinetic (cogwheel rigidity and tremors at rest) features are displayed by Parkinsonism.[3] These are the four motor symptoms found in Parkinson's disease (PD) – after which it is named – dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and many other conditions. This set of symptoms occurs in a wide range of conditions and may have many causes, including neurodegenerative conditions, drugs, toxins, metabolic diseases, and neurological conditions other than PD.[4]

Parkinsonism
SpecialtyNeurology Edit this on Wikidata
Causes

Signs and symptoms

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Parkinsonism is a clinical syndrome characterized by the four motor symptoms found in Parkinson's disease: tremor, bradykinesia (slowed movements), rigidity, and postural instability.[1][2]

Parkinsonism gait problems can lead to falls and serious physical injuries. Other common symptoms include:

Conditions

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Parkinsonism occurs in many conditions.

Neurological

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Neurodegenerative conditions and Parkinson-plus syndromes that can cause parkinsonism include:[6]

Infectious

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Toxins

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Evidence exists to show a link between exposure to pesticides and herbicides and PD; a two-fold increase in risk was seen with paraquat or maneb/mancozeb exposure.[12]

Chronic manganese (Mn) exposure has been shown to produce a parkinsonism-like illness characterized by movement abnormalities.[13] This condition is not responsive to typical therapies used in the treatment of PD, suggesting an alternative pathway than the typical dopaminergic loss within the substantia nigra.[13] Manganese may accumulate in the basal ganglia, leading to the abnormal movements that characterize parkinsonism.[14] A mutation of the SLC30A10 gene, a manganese efflux transporter necessary for decreasing intracellular Mn, has been linked with the development of this parkinsonism-like disease.[15] The Lewy bodies typical to PD are not seen in Mn-induced parkinsonism.[14]

Agent Orange may be a cause of parkinsonism, although evidence is inconclusive and further research is needed.[16]

Other toxins that have been associated with parkinsonism are:

Vascular

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Other

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Differential diagnosis

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Secondary parkinsonism, including vascular parkinsonism and drug-induced parkinsonism.[35][36]

Drug-induced parkinsonism

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About 7% of people with parkinsonism developed symptoms as a result of side effects of medication, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupentixol and zuclopenthixol) and butyrophenones (such as haloperidol), and rarely, antidepressants. Yet another drug that can induce parkinsonism is the antihistaminic medication cinnarizine, usually prescribed for motion sickness; this is because besides antagonizing histamine receptors this drug antagonizes the dopamine D2 receptors.[37] The incidence of drug-induced parkinsonism increases with age. Drug-induced parkinsonism tends to remain at its presenting level and does not worsen like Parkinson's disease.[38]

Implicated medications include:

Society and culture

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In the United States, the 2021 National Defense Authorization Act (NDAA) added parkinsonism to the list of presumptive conditions associated with Agent Orange exposure, enabling affected service members to receive Veterans Affairs disability benefits.[42] 

References

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  • GeneReviews/NIH/NCBI/UW entry on Perry syndrome
  • GeneReviews/NCBI/NIH/UW entry on X-Linked Dystonia-Parkinsonism

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