Drug-induced parkinsonism: diagnosis and treatment.

IF 3 3区 医学 Q2 PHARMACOLOGY & PHARMACY Expert Opinion on Drug Safety Pub Date : 2024-10-25 DOI:10.1080/14740338.2024.2418950
Hannah Conn, Joseph Jankovic
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Abstract

Introduction: Drug-induced parkinsonism (DIP) is one of the most common iatrogenic movement disorders. It is characterized by tremors, slowness of movement, and shuffling gait with postural instability, clinically indistinguishable from idiopathic Parkinson's disease. Prior exposure to antipsychotic medications or other dopamine receptor blocking agents (DRBAs) is required for the diagnosis.

Areas covered: This article aims to review the epidemiology, pathophysiology, clinical features, ancillary testing, and treatment of DIP. A literature search was undertaken in PubMed from January 2013 to January 2024.

Expert opinion: A clinician's suspicion of DIP must always be present when a patient develops acute to subacute onset of parkinsonism while taking a DRBA. As DIP can be indistinguishable from idiopathic PD, ancillary testing, such as DaTscans and skin biopsy searching for alpha-synuclein deposits, are often required to make a definitive diagnosis. When DIP develops, steps should be taken to discontinue the offending agent or, in the case of antipsychotics, dose reduction or change to an agent with lower risk for DIP, such as quetiapine or clozapine. Prophylactic treatment with anticholinergics is not indicated.

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药物引起的帕金森病:诊断和治疗。
简介药物诱发帕金森病(DIP)是最常见的先天性运动障碍之一。其特点是震颤、行动迟缓、步态不稳,临床上与特发性帕金森病无异。确诊时需要先服用抗精神病药物或其他多巴胺受体阻断剂(DRBAs):本文旨在回顾 DIP 的流行病学、病理生理学、临床特征、辅助检查和治疗。在PubMed上搜索了2013年1月至2024年1月的文献:当患者在服用 DRBA 时出现急性或亚急性帕金森病发作时,临床医生必须始终怀疑 DIP 的存在。由于 DIP 可能与特发性帕金森病难以区分,因此通常需要进行辅助检查,如 DaTscans 和皮肤活检,以寻找α-突触核蛋白沉积物,从而做出明确诊断。当出现 DIP 时,应采取措施停用违规药物,如果是抗精神病药物,则应减少剂量或改用 DIP 风险较低的药物,如喹硫平或氯氮平。无需使用抗胆碱能药物进行预防性治疗。
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来源期刊
CiteScore
5.90
自引率
3.20%
发文量
97
审稿时长
6-12 weeks
期刊介绍: Expert Opinion on Drug Safety ranks #62 of 216 in the Pharmacology & Pharmacy category in the 2008 ISI Journal Citation Reports. Expert Opinion on Drug Safety (ISSN 1474-0338 [print], 1744-764X [electronic]) is a MEDLINE-indexed, peer-reviewed, international journal publishing review articles on all aspects of drug safety and original papers on the clinical implications of drug treatment safety issues, providing expert opinion on the scope for future development.
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