Parkinsonism - secondary
Secondary parkinsonism is a disorder similar to Parkinson’s disease, but is caused by the effects of a medication, a neurodegenerative disorder, or another illness.
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.
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.
Medications including tranquilizers (such as haloperidol), metoclopramide, and phenothiazine medications; exposure to narcotics or anesthesia agents (such as for surgery); exposure to toxins, carbon monoxide poisoning, recreational use of MPTP or other drugs (a common cause in adolescents); or it may occasionally be caused by other conditions.
Secondary parkinsonism caused by medications is usually reversible. If it is caused by toxins, infections, or disorders it may or may not be reversible.
Parkinsonism causes abnormality of movements due to dysreguation of neurotransmitters in the brain. The most common abnormality is in dopamine. This may result in stiffness of the trunk, arms or legs, a decrease in facial expression, tremor as well as other symptoms.
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.
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. Some cases may not be preventable.
Initial symptoms may be mild and nonspecific (such as mild tremor, slight feeling that one leg/foot is stiff or dragging).
Symptoms that may also be seen or develop:
The health care provider may be able to diagnose secondary parkinsonism based on the patient’s history, presenting 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 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.
The treatment is aimed at control of symptoms. If the symptoms are mild, no treatment may be required.
If the condition is caused by a medication, the benefits of the medication may be weighed against the severity of symptoms. If appropriate, medications may be stopped or changed by the health care provider.
Treatment of underlying conditions (such as stroke, infections) may reduce symptoms.
Medications may be used if symptoms interfere with the ability to perform daily activities. The medication, or dose, timing, or combination may need to be adjusted as symptoms change.
Many of the medications may cause severe side effects, so monitoring and follow up by the health care provider are important. As a rule, response in secondary parkinsonism is less responsive to all medical therapy compared to Parkinson’s disease.
Medications include:
Additional medications may 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 the symptoms worse.
Physical therapy, speech therapy, and occupational therapy may help promote function and independence, and may help maintain skills, positive attitude, and minimize depression.
Simple aides 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).
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.
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.
Call your health care provider if symptoms of secondary parkinsonism 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.
Discuss the situation with your health care provider if you are unable to care for the person at home.