Parkinsonism

Parkinsonism
Classification and external resources
Specialty	neurology
ICD-10	G20-G21
ICD-9-CM	332
DiseasesDB	24212
MedlinePlus	000759
MeSH	D020734

Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia, rigidity, and postural instability.^[1][2] Parkinsonism shares symptoms found in Parkinson's disease, from which it is named; but parkinsonism is a symptom complex, and differs from Parkinson disease which is a progressive neurodegenerative illness. The underlying causes of parkinsonism are numerous, and diagnosis can be complex.^[3][4] The neurodegenerative condition Parkinson's disease (PD) is the most common cause of parkinsonism. However, a wide range of other etiologies may lead to a similar set of symptoms, including some toxins, a few metabolic diseases, and a handful of neurological conditions other than Parkinson's.^[5]

About 7% of people with parkinsonism have developed their symptoms following treatment with particular medications. Side effect of medications, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupenthixol and zuclopenthixol) and butyrophenones (such as haloperidol (Haldol)), piperazines (such as ziprasidone), and, rarely, antidepressants. The incidence of drug-induced parkinsonism increases with age. Drug induced parkinsonism tends to remain at its presenting level, i.e. does not progress like the parkinson disease.^[6]

Differential diagnoses

Before Parkinson's disease is diagnosed the differential diagnoses include:

• AIDS can sometimes lead to the symptoms of secondary parkinsonism, due to commonly causing dopaminergic dysfunction. Indeed, parkinsonism can be a presenting feature of HIV infection.^[7]
• Corticobasal degeneration^[1]
• Creutzfeldt-Jakob disease^[8]
• Dementia pugilistica or "boxer's dementia" is a condition that occurs in boxers due to chronic brain trauma
• Diffuse Lewy body disease^[1]
• Drug-induced parkinsonism ("pseudoparkinsonism") due to drugs such as antipsychotics, metoclopramide, MPTP^[1][9]
• Encephalitis lethargica^[1]
• Essential tremor, an illness which has some diagnostic overlap with Parkinson's disease.^[10]
• Multiple system atrophy^[11]
• Pantothenate kinase-associated neurodegeneration, also known as Neurodegeneration with brain iron accumulation (NBIA) or Hallervorden-Spatz syndrome^[12][13]
• Parkinson plus syndrome
• Progressive supranuclear palsy^[1]
• Toxicity due to substances such as carbon monoxide,^[14] carbon disulfide,^[14] manganese,^[14] paraquat,^[15] mercury,^[16] hexane, rotenone, and toluene^[17] (inhalant abuse: "huffing")^[18]
• Vascular parkinsonism, associated with underlying cerebrovascular disease^[19][20]
• Wilson's disease is a genetic disorder in which there is an abnormal accumulation of copper. The excess copper can lead to the formation of a copper-dopamine complex, which leads to the oxidation of dopamine to aminochrome.^[21] The most common manifestations include bradykinesia, cogwheel rigidity^[22] and a lack of balance.^[23]
• Paraneoplastic syndrome: neurological symptoms caused by antibodies associated with cancers
• Genetic
  • Rapid onset dystonia parkinsonism (DYT12)
  • Parkin mutation
  • X-linked dystonia parkinsonism (DYT3)
  • Autosomal recessive juvenile parkinsonism (ARJP)

References

1. Aminoff MJ, Greenberg DA, Simon RP (2005). Clinical Neurology (6th ed.). Lange: McGraw-Hill Medical. pp. 241–5. ISBN 0-07-142360-5.
2. Bradley J. Robottom; William J. Weiner; Lisa M. Shulman. "42". International Neurology: A Clinical Approach. Blackwell Publishing Ltd. pp. 152–158. ISBN 978-1-405-15738-4.
3. Rao G, Fisch L, Srinivasan S, et al. Does this patient have Parkinson disease? JAMA. 2003;289(3):347-353. PMID 12525236
4. Tuite PJ, Krawczewski K (2007). "Parkinsonism: a review-of-systems approach to diagnosis". Seminars in neurology 27 (2): 113–22. doi:10.1055/s-2007-971174. PMID 17390256.
5. Christine CW, Aminoff MJ (2004). "Clinical differentiation of parkinsonian syndromes: prognostic and therapeutic relevance". Am. J. Med. 117 (6): 412–9. doi:10.1016/j.amjmed.2004.03.032. PMID 15380498.
6. http://www.parkinsons.org.uk/PDF/FS38_druginducedparkinsonism.pdf
7. Tse W, Cersosimo MG, Gracies JM, et al. (2004). "Movement disorders and AIDS: a review". Parkinsonism Relat. Disord. 10 (6): 323–34. doi:10.1016/j.parkreldis.2004.03.001. PMID 15261874.
8. Maltête D, Guyant-Maréchal L, Mihout B, Hannequin D (2006). "Movement disorders and Creutzfeldt-Jakob disease: a review". Parkinsonism Relat. Disord. 12 (2): 65–71. doi:10.1016/j.parkreldis.2005.10.004. PMID 16364674.
9. Watanabe Y, Himeda T, Araki T (2005). "Mechanisms of MPTP toxicity and their implications for therapy of Parkinson's disease" (PDF). Med. Sci. Monit. 11 (1): RA17–23. PMID 15614202.
10. http://www.news-medical.net/news/20090902/LINGO1-variant-responsible-for-essential-tremors-and-Parkinsons-disease.aspx
11. Wenning GK, Geser F (2003). "Multiple system atrophy". Rev. Neurol. (Paris) 159 (5 Pt 2): 3S31–8. PMID 12773886.
12. Uc EY, Rodnitzky RL (2003). "Childhood dystonia". Seminars in pediatric neurology 10 (1): 52–61. doi:10.1016/S1071-9091(02)00010-4. PMID 12785748.
13. Online 'Mendelian Inheritance in Man' (OMIM) NEURODEGENERATION WITH BRAIN IRON ACCUMULATION 1; NBIA1 -234200
14. DeLong MR, Juncos JL (2004). Parkinson's Disease and Other Movement Disorders. In: Harrison's Principles of Internal Medicine (16th ed.). McGraw-Hill Professional. p. 2414. ISBN 0-07-140235-7.
15. Dinis-Oliveira RJ, Remião F, Carmo H, et al. (2006). "Paraquat exposure as an etiological factor of Parkinson's disease". Neurotoxicology 27 (6): 1110–22. doi:10.1016/j.neuro.2006.05.012. PMID 16815551.
16. Tremor/InvoluntaryMovements: Excerpt from Field Guide to Bedside Diagnosis
17. Weiss J. Chapter 151. Toluene and Xylene. In: Olson KR, ed. Poisoning & Drug Overdose. 6th ed. New York: McGraw-Hill; 2012. http://www.accessmedicine.com/content.aspx?aID=55982958. Accessed April 21, 2013.
18. http://onlinelibrary.wiley.com/doi/10.1002/ana.410350516/abstract
19. Thanvi B, Lo N, Robinson T (2005). "Vascular Parkinsonism--an important cause of parkinsonism in older people" (PDF). Age and ageing 34 (2): 114–9. doi:10.1093/ageing/afi025. PMID 15713855.
20. http://parkinsonsdiseasefoundation.blogspot.com/2012/08/vascular-parkinsonism.html
21. Członkowska A, Tarnacka B, Möller JC, et al. (2007). "Unified Wilson's Disease Rating Scale — a proposal for the neurological scoring of Wilson's disease patients". Neurol. Neurochir. Pol. 41 (1): 1–12. PMID 17330175.
22. Ropper AH, Samuels MA. Chapter 4. Abnormalities of Movement and Posture Caused by Disease of the Basal Ganglia. In: Ropper AH, Samuels MA, eds. Adams and Victor's Principles of Neurology. 9th ed. New York: McGraw-Hill; 2009. http://www.accessmedicine.com/content.aspx?aID=3630437. Accessed April 21, 2013.
23. Lorincz MT (January 2010). "Neurologic Wilson's disease". Ann. N. Y. Acad. Sci. 1184: 173–87. doi:10.1111/j.1749-6632.2009.05109.x. PMID 20146697.

External links

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