The differential diagnosis includes mitochondrial dysfunction, psychogenic non-epileptic seizures, drug-induced symptomology, drug-induced parkinsonism
, vasovagal response and syncope, and systemic infection secondary to oral microbial toxins.
Clinical features of drug-induced Parkinsonism
and Parkinson's disease (15) Variables Drug-induced Parkinsonism
parkinsonism Symptoms at onset Bilateral and symmetric Unilateral or or asymmetric asymmetric Onset Acute or subacute Chronic Course with Regressive Progressive appropriate treatment Response to Evident Mild to moderate anticholinergic drugs Response to levodopa Poor Marked Akathisia Present Absent Other associated Oro-buccal dyskinesia Motor fluctuations features and rabbit syndrome Incidence of rest More evident Less evident tremor Gender More in females More in males Freezing Uncommon Common
A recent systematic review of the untoward effects of valproate showed that drug-induced parkinsonism
is a relatively common side effect in elderly women (6).
Cigarete smoking: effects on cognitive functions and drug-induced Parkinsonism
in chronic schizophrenia.
Lee, "Persistent drug-induced parkinsonism
in patients with normal dopamine transporter imaging," PLoS ONE, vol.
Cases misdiagnosed as PD by referring doctors include MSA (3 cases), PSP (2 cases), ET (1 case), drug-induced Parkinsonism
(1 case), vascular Parkinsonism (2 cases), UP (2 cases), and others (3 cases).
Other forms of the disease include vascular Parkinsonism, thought to be caused by hypertension and diabetes, drug-induced Parkinsonism
, which is most often a result of neuroleptic drugs used to treat psychotic disorders, and inherited Parkinson's, which is passed through family members.
Montastruc, "Drug-induced parkinsonism
: a review of 17 years' experience in a regional pharmacovigilance center in France," Movement Disorders, vol.
Procyclidine is an anticholinergic drug principally used for the treatment of Drug-induced Parkinsonism
, Parkinson disease and others.
The differential diagnoses for Parkinsonism include normal aging, drug-induced Parkinsonism
, Parkinson-plus (progressive supranuclear palsy, corticobasal degeneration, multiple system atrophy), vascular Parkinsonism, normal pressure hydrocephalus.
was observed in 10 patients (7.6%) treated with trimetazidine only, with an additional 10 patients (7.6%) simultaneously receiving other drugs potentially capable of inducing movement disorders.
(35) One reason that diagnosis of PD is challenging is that PCPs are tasked with differentiating PD from conditions that may have clinically similar features, including essential tremor (ET), drug-induced parkinsonism
, vascular parkinsonism, and MSA.