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Alternative names Return to top
Parkinsonism - secondaryDefinition Return to top
Secondary parkinsonism is a disorder with symptoms similar to Parkinson's disease, but is caused by medication side-effects, a different neurodegenerative disorder, or another illness.Causes, incidence, and risk factors Return to top
Parkinson's disease is one of the most common neurologic disorders of the elderly. The term "parkinsonism" refers to any condition that causes any combination of the types of movement abnormalities seen in Parkinson's disease by damaging or destroying dopamine neurons in a certain area of the brain.
Secondary parkinsonism may be caused by disorders such as a stroke, encephalitis, or meningitis. Other neurodegenerative disorders such as progressive supranuclear palsy, corticobasal degeneration, and multiple systems atrophy can also damage the dopamine neurons and produce this condition.
Medications including antipsychotics such as haloperidol, metoclopramide, and phenothiazine medications are another common cause of secondary parkinsonism.
Less frequently, exposure to overdoses of narcotics or brain damage caused by anesthesia agents (such as during surgery); exposure to toxins, and carbon monoxide poisoning can cause secondary parkinsonism if they damage the brain area that contains the dopamine neurons.
There have been clusters of cases among intravenous drug users who injected a substance called MPTP, which is a byproduct of an improper technique for synthesizing a form of synthetic heroin (fentanyl derivative). These cases are rare and have affected primarily long-term drug users.
Secondary parkinsonism caused by medications like antipsychotics is usually reversible. If it is caused by toxins, infections, drug-related brain damage, or certain other disorders it may or may not be reversible.
Symptoms of parkinsonism may include stiffness of the trunk, arms, or legs, a decrease in facial expression, soft voice, tremor, some forms of paralysis, and certain problems with control of movement.
Although cognitive dysfunction is not a major feature of Parkinson's disease, it may be more prominent in secondary parkinsonism as the diseases that cause secondary parkinsonism more commonly also result in dementia.
Symptoms Return to top
Initial symptoms may be mild and nonspecific (such as mild tremor, slight feeling that one leg/foot is stiff or dragging).Signs and tests Return to top
The health care provider may be able to diagnose secondary parkinsonism based on the patient's history, symptoms, and physical examination. However, the symptoms may be difficult to assess, particularly in the elderly.
For example, the tremor may not appear when the person is sitting quietly with the arms in the lap. The posture changes may be similar to those caused by osteoporosis or other changes associated with aging. The lack of facial expression may be a sign of depression.
Examination may show increased muscle tone, tremors of the Parkinson's type, and difficulty initiating or completing voluntary movements. Reflexes are usually normal.
Tests are not usually specific for secondary parkinsonism but may be used to confirm or rule out other disorders that may cause similar symptoms.
Treatment Return to top
Treatment is aimed controlling symptoms. If the symptoms are mild, no treatment may be required.
If the condition is caused by a medication, the benefits of the medication should be weighed against the severity of symptoms and stopped or changed if they seem counterproductive.
Treatment of underlying conditions (such as stroke, infections) can reduce symptoms.
Medications may be used if symptoms interfere with the ability to perform daily activities. The medication, or dose, timing or combination of medications may need to be adjusted as symptoms change.
Many of the medications used to treat this condition can cause severe side effects, so monitoring and follow-up by the health care provider are important. Secondary parkinsonism tend to be less responsive to medical therapy than Parkinson's disease.
Medications include:
Support Groups Return to top
Emotional support may help in coping with the changes caused by the disease. This may include the National Parkinson's Foundation or other support groups (see Parkinson's disease - support group).Expectations (prognosis) Return to top
The outcome varies and depends on the cause. If the disorder is caused by medications, it is potentially treatable. All other causes are not reversible and, to a greater or lesser degree, progressive.Complications Return to top
Calling your health care provider Return to top
Call your health care provider if symptoms of secondary parkinsonism develop, recur, worsen, or progress.Prevention Return to top
The treatment of conditions that may cause secondary parkinsonism may decrease the risk of its development. Medication use should only be under the supervision of the health care provider and people with conditions that require long-term use of antipsychotics, like schizophrenia, should be carefully monitored to avoid development of irreversible secondary parkinsonism. Newer antipsychotic medications are less likely to cause secondary parkinsonism. Update Date: 7/13/2004 Updated by: Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |