Secondary and Atypical Parkinsonism

Parkinsonism results from drugs, disorders other than Parkinson disease Parkinson Disease Parkinson disease is a slowly progressive, degenerative disorder characterized by resting tremor, stiffness (rigidity), slow and decreased movement (bradykinesia), and eventually gait and/or... read more , or exogenous toxins.

The most common cause of secondary parkinsonism is

These drugs include

Clinical features of secondary and atypical parkinsonism are similar to those of Parkinson disease Symptoms and Signs Parkinson disease is a slowly progressive, degenerative disorder characterized by resting tremor, stiffness (rigidity), slow and decreased movement (bradykinesia), and eventually gait and/or... read more (eg, resting tremor, rigidity, bradykinesia, postural instability).

To differentiate Parkinson disease from secondary or atypical parkinsonism, clinicians note whether levodopa results in dramatic improvement, suggesting Parkinson disease.

Causes of parkinsonism can be identified by the following:

Deficits that suggest neurodegenerative disorders other than Parkinson disease include gaze palsies Conjugate Gaze Palsies A conjugate gaze palsy is inability to move both eyes together in a single horizontal (most commonly) or vertical direction. Gaze palsies most commonly affect horizontal gaze; some affect upward... read more , signs of corticospinal tract dysfunction (eg, hyperreflexia), myoclonus Myoclonus Myoclonus is a brief, shocklike contraction of a muscle or group of muscles. Diagnosis is clinical and sometimes confirmed by electromyographic testing. Treatment includes correction of reversible... read more , autonomic dysfunction Overview of the Autonomic Nervous System The autonomic nervous system regulates physiologic processes. Regulation occurs without conscious control, ie, autonomously. The 2 major divisions are the Sympathetic system Parasympathetic... read more (if early or severe), cerebellar ataxia Cerebellar Disorders Cerebellar disorders have numerous causes, including congenital malformations, hereditary ataxias, and acquired conditions. Symptoms vary with the cause but typically include ataxia (impaired... read more , prominent dystonia Dystonias Dystonias are sustained involuntary muscle contractions of antagonistic muscle groups in the same body part, leading to sustained abnormal posturing or jerky, twisting, intermittent spasms that... read more , ideomotor apraxia (inability to mimic hand motions), early dementia Dementia Dementia is chronic, global, usually irreversible deterioration of cognition. Diagnosis is clinical; laboratory and imaging tests are usually used to identify treatable causes. Treatment is... read more , early falls, and confinement to a wheelchair.

The cause of secondary parkinsonism is corrected or treated if possible, sometimes resulting in clinical improvement or disappearance of symptoms.

Drugs used to treat Parkinson disease are often ineffective or have only transient benefit. But amantadine or an anticholinergic drug (eg, benztropine) may ameliorate parkinsonism secondary to use of antipsychotic drugs. However, because these drugs may worsen cognitive decline and possibly increase tau pathology and neurodegeneration, their use should be limited (1 Treatment references Secondary parkinsonism refers to a group of disorders that have features similar to those of Parkinson disease but have a different etiology. Atypical parkinsonism refers to a group of neurodegenerative... read more , 2 Treatment references Secondary parkinsonism refers to a group of disorders that have features similar to those of Parkinson disease but have a different etiology. Atypical parkinsonism refers to a group of neurodegenerative... read more ).

Physical measures to maintain mobility and independence are useful (as for Parkinson disease). Maximizing activity is a goal. Patients should increase daily activities to the greatest extent possible. If they cannot, physical or occupational therapy, which may involve a regular exercise program, may help condition them physically. Therapists may teach patients adaptive strategies, help them make appropriate adaptations in the home (eg, installing grab bars to reduce the risk of falls), and recommend adaptive devices that may be useful.

Good nutrition is essential.