Parkinsonism

Parkinsonism
SpecialtyNeurology 
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Causes

Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia (slowed movements), rigidity, and postural instability.[1][2] 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. A wide range of causes may lead to this set of symptoms, including neurodegenerative conditions, drugs, toxins, metabolic diseases, and neurological conditions other than PD.[3]

Causes

Drug-induced

About 7% of people with parkinsonism developed symptoms as a result of side effects of medications, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupenthixol 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.[4] 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.[5]

Toxins

Evidence exists of a link between exposure to pesticides and herbicides and PD; a two-fold increase in risk was seen with paraquat or maneb/mancozeb exposure.[6]

Chronic manganese (Mn) exposure has been shown to produce a parkinsonism-like illness characterized by movement abnormalities.[7] 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.[7] Manganese may accumulate in the basal ganglia, leading to the abnormal movements.[8] 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.[9] The Lewy bodies typical to PD are not seen in Mn-induced parkinsonism.[8]

Diagnosis

Parkinsonism occurs in many conditions.

Neurodegenerative conditions and Parkinson plus syndrome[10]
Drug-induced ("pseudoparkinsonism")
Infectious
Toxins
Trauma
Vascular
Other

Essential tremor

A 2018 review article said that the relationship (if any) between Parkinson's disease and essential tremor is not clear.[32]

References

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  2. Ogawa T, Fujii S, Kuya K, Kitao SI, Shinohara Y, Ishibashi M, Tanabe Y (September 2018). "Role of neuroimaging on differentiation of Parkinson's disease and its related diseases". Yonago Acta Med (Review). 61 (3): 145–55. doi:10.33160/yam.2018.09.001. PMC 6158357. PMID 30275744. Parkinsonian syndromes are a group of movement disorders characterized by classical motor symptoms such as tremors, bradykinesia, and rigidity. They are most frequently due to primary neurodegenerative disease, resulting in the loss of dopaminergic nerve terminals along the nigrostriatal pathway, similar to idiopathic PD, MSA, PSP, CBD, and DLB.
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