A disorder similar to Parkinson's disease , but which is caused by the effects of a medication, a different neurodegenerative disorder or another illness.

Alternative Names

Parkinsonism - secondary

Causes, incidence, and risk factors

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 these 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 which contains these neurons. There have been clusters of cases amongst 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.

Signs and tests

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 it may be used to confirm or rule out other disorders that may cause similar symptoms.

Treatment

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:

Amantadine or anticholinergic medications

Levodopa/carbidopa

Dopamine agonists

Additional medications include antihistamines, antidepressants, monoamine oxidase inhibitors or others to help reduce symptoms or control the side effects of primary treatment medications. Good general nutrition and health are important. Exercise should continue, with the level of activity adjusted to meet the changing energy levels that may occur. Regular rest periods and avoidance of stress are recommended, because tiredness or stress can make symptoms worse. Physical therapy, speech therapy and occupational therapy may help promote function and independence, and may help maintain skills and positive attitude and minimize depression . Simple aids such as railings or banisters placed in commonly used areas of the house, special eating utensils or other devices may be of great benefit to the person experiencing some difficulties with daily living activities. Social work or other counseling services may help in coping with the disorder, and obtaining assistance as appropriate (such as safety equipment, Meals-on-Wheels, volunteer services or other assistance).

Support groups

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)

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

Disability, varying degrees

Difficulty swallowing

(eating)

Difficulty performing daily activities

Injuries from falls

Side effects of medications

Debilitation and associated conditions:

Malnutrition

Aspiration

Deep vein thrombosis

Calling your health care provider

Call your health care provider if symptoms of secondary parkinsonism develop, recur, worsen or progress.

Call your health care provider if new symptoms appear in a person with this disorder, including possible side effects of medications: involuntary movements, nausea/vomiting , dizziness , changes in alertness/behavior/mood, severe confusion or disorientation, delusional behavior, hallucinations , loss of mental functions or any other new symptoms that develop (see also information on potential side effects of the specific medication). Discuss the situation with your health care provider if you are unable to care for the person at home (after initial treatment).

Prevention

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.