各国关于DIP的报告
日本
Nippon Rinsho. 1997 Jan;55(1):112-7.
[Drug-induced parkinsonism]
[Article in Japanese]
Kuzuhara S.
Department of Neurology, Mie University School of Medicine.
Drug-induced parkinsonism(DIP) is at present the second most frequent cause of parkinsonism next to idiopathic Parkinson’s disease(PD) in Japan. The ratio of the incidence of DIP to PD has been reported to be between 1:2 and 1:5, which varied at the period surveyed. The most frequent causative drugs were calcium-blocking agents, flunarizine and cinnarizine in 1980s, and they have been replaced in recent years by benzamide derivatives with antipsychotic, antiemetic or prokinetic actions, sulpiride, tiapride and metoclopraramide. The clinical features of DIP are similar to those of PD except for rather rapid progression of the symptoms. Careful neurological examination and check of all drugs the patient has taken are important for correct diagnosis. Most causative drugs act as the dopamine D2 receptor blocker in the brain and discontinuance of the drug(s) is necessary for the treatment. Parkinsonian symptoms begin to improve in several weeks and patients are relieved from the symptoms usually within several months.
英国
Postgrad Med J. 2009 Jun;85(1004):322-6.
Drug induced parkinsonism: a common cause of parkinsonism in older people.
Thanvi B, Treadwell S.
South Warwickshire Hospital, Lakin Road, Warwick CV34 5BW, UK. bhomraj.thanvi@swh.nhs.uk
Drug induced parkinsonism is the second most common cause of parkinsonism in older people after idiopathic Parkinson’s disease (PD). Risk factors for developing drug induced parkinsonism include: older age; female gender; dose and duration of treatment; type of agent used; cognitive impairment; acquired immunodeficiency syndrome (AIDS); tardive dyskinesia; and pre-existing extrapyramidal disorder. In most patients parkinsonism is reversible upon stopping the offending drug, though it may take several months to resolve fully and in some patients it may even persist. In this case, one needs to consider the possibility of PD which has been unmasked by the offending drug, and treatment with dopaminergic agents may be warranted. Drug induced parkinsonism adversely affects the quality of life in older patients and is potentially reversible, highlighting the importance of early recognition of this condition. This article discusses the drugs implicated, as well as the epidemiology, pathophysiology, clinical features, and management of drug induced parkinsonism.
法国
Rev Neurol (Paris). 1994 Nov;150(11):757-62.
[Drug-induced parkinsonian syndromes: a 10-year experience at a regional center of pharmaco-vigilance]
[Article in French]
Llau ME, Nguyen L, Senard JM, Rascol O, Montastruc JL.
Service de Pharmacologie Clinique, Centre Hospitalier Universitaire, Faculté de Médicine, Toulouse.
Besides classical neuroleptics, several drugs can induce parkinsonian symptoms. The present retrospective study investigates the characteristics of drug-induced parkinsonism notified to the Midi-Pyrénées Pharmacovigilance Centre between 1983 and 1992. Among 3,923 side effects spontaneously reported between 1983 and 1992 to the center, 53 (1.4%) were drug-induced parkinsonism. Mean age was 65 +/- 2 (s.e.m.) years (range 21-88). Drug-induced parkinsonism appeared after a mean treatment duration of 473 +/- 142 days (range 1 day to 15 years) and occurred most frequently in women (63%). The occurrence onset of drug-induced Parkinsonism exhibited a bimodal pattern with a first peak (between 0 and 6 months) mainly due to peripheral or central antidopaminergic drugs and a second one later (between 9 and 12 months) due mostly to calcium channel blockers. Involved drugs were mostly antidopaminergic agents: neuroleptics (antipsychotic drugs: 39%) but also agents used for nausea or vomiting (domperidone, metoclopramide, metopimazine or triethylperazine: 12%) or symptoms associated with menopause (veralipride: 6%). Other cases were related mainly to drugs with "calcium channel blocker" properties (flunarizine and cinnarizine: 30%), H1 antihistamine (1 case), fluoxetine (1 case), alphamethyldopa (1 case) or reserpine (1 case) whereas 3 cases were due to drug interactions. Imputability scores (according to the method of assessment of unexpected drug reactions used in France) were "doubtful" （11%), "plausible" (34%) and "probable" (53%). The complete triad (tremor, akinesia plus rigidity) was seen in 13 (25%) cases. Symmetrical symptoms occurred in 41 (77%) patients. A total disappearance of the clinical feature occurred in 39 (74%) patients whereas in 8 cases (15%), drug-induced parkinsonism led to the diagnosis of underlying idiopathic Parkinson’s
disease. The present study shows that around 80% of drug-induced parkinsonism are due to two pharmacological classes: central and peripheral antidopaminergic agents and calcium channel blockers.
西班牙
Rev Neurol. 1998 Jul;27(155):35-9.
[Drug-induced parkinsonism. Clinical aspects compared with Parkinson disease]
[Article in Spanish]
Errea-Abad JM, Ara-Callizo JR, Aibar-Remón C.
Servicio de Neurología, Hospital Comarcal de Barbastro, Huesca.
INTRODUCTION: Drug-induced Parkinsonism (DIP) is the second commonest cause of Parkinson syndrome, after Parkinson disease (PD) and represents between 10% and 30% of all patients with Parkinsonism. OBJECTIVES: To study the frequency and drugs responsible for DIP and to compare some of the clinical characteristics of these patients and those with PD. PATIENTS AND METHODS: A retrospective community based study in Bajo Aragon district to determine the frequency of PD and other Parkinsonism, including DIP. PD was diagnosed on the criteria proposed by the United Kingdom Parkinson’s Disease Society Brain Bank and DIP on the criteria of Jiménez et al. RESULTS: Calcium antagonists were the cause of 73% of the DIP, followed by euroleptic drugs (11.5%). There were 73% women (19/26). The patients with DIP were older than those with PD when their symptoms started (p = 0.02). In patients with DIP, 48% presented with bilateral symptoms as compared with 7% in PD (p < 0.0001). CONCLUSIONS: 1. Cinarizine is the main drug responsible for DIP (58%) 2. As compared with patients with PD, patients with DIP are mainly women, older, more frequently have bilateral onset of symptoms and consult the doctor sooner.
阿根庭
Drugs Aging. 1994 Aug;5(2):127-32.
Drug-induced parkinsonism in the aged. Recognition and prevention.
Gershanik OS.
Seccion Enfermedades Extrapiramidales, Centro Neurologico-Hospital Frances, Buenos Aires, Argentina.
Drug-induced Parkinsonism is a frequent adverse effect of numerous drugs interfering with dopamine function at the basal ganglionic level. It accounts for 4% of all patients with Parkinsonism seen in neurology clinics. Pharmacological agents implicated in the production of this disorder have a wide range of applications in medicine, beyond the treatment of psychiatric
illnesses. Antipsychotics, substituted benzamides and calcium channel blockers are the drugs most commonly involved. The aged population is at an increased risk of drug-induced Parkinsonism due to intrinsic factors and because they often receive multiple drugs, including those from self-medication. Lack of knowledge in the medical profession of the potential hazards involved in the use of certain drugs plays a contributory role in the development of drug-induced Parkinsonism. Physicians should be always alert in order to detect, as early as possible, the presence of extrapyramidal symptoms in patients exposed to medications with antidopaminergic properties. Whenever possible, withdrawal of the medication will help resolve symptoms; complete remission takes place within 6 to 18 months in the majority of patients. The use of anti-Parkinsonian drugs is only advisable if the symptomatology is disabling. The best available treatment is prevention.
美国
Mov Disord. 2008 Feb 15;23(3):401-4.
Failure of recognition of drug-induced parkinsonism in the elderly.
Esper CD, Factor SA.
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia 30329, USA.
Our objective was to evaluate the ability of neurologists to recognize and diagnose drug-induced Parkinsonism (DIP) in the elderly. DIP is a diagnostic challenge because it can be indistinguishable from Parkinson’s disease, especially in the elderly. It is frequently under-recognized by psychiatrists and primary care physicians. Atypical antipsychotics (AA) are advertised for their low propensity to cause DIP. This may add to problems with recognition. We performed a retrospective record review of consecutive new parkinsonian patients seen over 2 years in a movement disorders clinic to examine the frequency, causative agents, and diagnostic accuracy of DIP by physicians, particularly neurologists. Of 354 Parkinsonian patients evaluated, 24 (6.8%) had DIP, 46% of these were due to AA and 29% were caused by toclopramide. Of the 24 patients with DIP, only one was previously diagnosed accurately according to records. Nineteen patients (79%) were previously evaluated by a neurologist, and none of them was diagnosed with DIP. The primary reason for failure to recognize DIP relates to under-recognition of AA as possible cause. A majority remained on the inciting agents while dopaminergic drugs were prescribed. DIP was reversible when the inciting drug was stopped. DIP is a common form of parkinsonism and is under-recognized, even by neurologists. AA and metoclopramide do not appear to be well-known to cause DIP. Cessation of the offending agent results in improvement of symptoms and would eliminate the need for dopaminergic agents, which are known to commonly cause side effects in the elderly. 2007 Movement Disorder Society
巴西
Parkinsonism Relat Disord. 2004 Jun;10(4):243-5.
Flunarizine and cinnarizine-induced parkinsonism: a historical and clinical analysis.
Teive HA, Troiano AR, Germiniani FM, Werneck LC.
Department of Internal Medicine, Hospital de Clínicas, Movement Disorders Unit, Neurology Service, Federal University of Paraná, 1103/102, Rua General Carneiro, 80060-150 Centro, Curitiba, Pr, Brazil. hagteive@mps.com.br
BACKGROUND: Drug-Induced Parkinsonism (DIP) represents the second leading cause of Parkinsonism (PK) in several countries.
Flunarizine and cinnarizine are some of the most common drugs that cause DIP. This paper reviews the first description of Flunarizine and Cinnarizine-Induced Parkinsonism (FCIP), as well as the subsequent literature, emphasizing epidemiological, clinical and diagnostic aspects. METHODS: We reviewed the literature on the subject, with special emphasis on the first description and the later definition of the clinical syndrome that results from chronic use of flunarizine and cinnarizine. RESULTS: In 1984, De Melo-Souza reported the first description of flunarizine-induced PK in five patients. Other reports followed on FCIP, emphasizing the clinical features, which are symmetrical parkinsonism, and depression, affecting mainly elderly women. CONCLUSIONS: Eighteen years after the original description, FCIP is a recognized condition with specific clinical features, and is the second most common cause of parkinsonism in many countries.
