Hello there. I joined here about 20 months ago after being diagnosed with tremor dominant PD. I suspected my aripiprazole was causing the symptoms. It was stopped and things improved but never completely went away. Now the symptoms seem to be creeping back. I have an appointment next week with the neurologist having contacted the service with my concerns.
Has anyone else here had apparently drug-induced PD which actually bounced back or, if it cleared up, how quickly did it go for you? I’ve read it can take 2 years to clear up for some people but can’t find an actual source for this statement. Any thoughts? I want to be prepared for my appointment but have also been struggling with the uncertainty for months now. Even if a DAT scan is arranged for me it could still be months until I know more.
Thanks for reaching out! We have some information on our website regarding drug-induced parkinsonism which you may find helpful.
Whilst there isn’t a specific time-frame most people do recover from drug-induced parkinsonism, often within a few days or weeks, once they have stopped taking the drug that causes the symptoms. Neuroleptic drugs (used to treat schizophrenia and other severe mental health conditions) are the biggest cause of drug induced parkinsonism. They block the action of the chemical dopamine in the brain.
If you would like any support or advice to help prepare you for your appointment then please do reach out to our helpline: 0808 800 0303.
Wishing you the best of luck.
Freya
Parkinson’s UK Moderation Team
Thank you for your reply. I’ll have a look at the website information.
I’ve done lots of personal tesearch and I don’t seem to fit the usual pattern for PD or DIP hence looking for personal experiences now. I am also struggling with almost 2 years of uncertainty and that prompted me to seek others’ experiences at this point.
Thank you again for the pointer.
Best wishes, Tania
Hi there - my husband suddenly got very poorly with stooped gait and balance issues etc. etc. - typical PD - and a really chronic cough that was so violent one night last Christmas time that I went on the internet in the middle of the night to check ‘what deficiency could cause a chronic cough’ and it was B12 deficiency - I have had his bloods tested on B12 and his levels were 680 top of the range 800 but I gave him 1,000 ug of B12 I happened to have in my stock and the cough went immediately - he had had this cough for over 10 years was told it was reflux - post nasal drip etc. etc. but it wasn’t at all. In my opinion this shows that the need for B12 in a PD scenario is far higher than a blood test result would show. Apparently a good way to see if B12 is getting into the cells is to have a homocysteine test and if that is high you have low B12. He has improved with his PD symptoms too and Vitamin D helped with balance issues so getting there without drugs being needed thank goodness. By the way if homocysteine is high then Vitamin B 6 will get this down as I have also proved and B6 helps with fatigue etc.
Some references which may be useful on this topic:
Clinical Algorithm. Parkinson’s Disease N P Quinn F A Husain BMJ vol. 293 9 Aug.1986
Drug induced parkinsonism is common … If the condition is due to drugs alone such patients usually recover after six months without medication, although 18 months to two years may occasionally be necessary …Those with drug induced parkinsonism may be at increased risk of developing idiopathic Parkinson’s disease later…
https://www.researchgate.net/publication/14117968_Drug-Induced_Movement_Disorders
Drug-induced parkinsonism in a movement disorders unit: A four-year survey. Jiménez-Jiménez FJ, Ortí-Pareja M, Ayuso-Peralta L, Gasalla T, Cabrera-Valdivia F, Vaquero A, Tejeiro J, García-Albea E. Parkinsonism & Related Disorders Vol.2, Issue 3, July 1996,
The diagnostic criteria for DIP included:
(1) the presence of two or more cardinal symptoms of parkinsonism,
(2) an absence of parkinsonian symptoms before the exposure to the offending drug,
(3) a disappearance or significant improvement in parkinsonism after withdrawal of the offending drug,
(4) no better explanation for the parkinsonism.
DIP was a frequent cause of parkinsonism in our Movement Disorder Unit…In many patients… the parkinsonian symptoms and signs do not completely disappear, despite withdrawal of the offending drug… a direct toxic effect on the dopaminergic system cannot be ruled out.
Drug-Induced Parkinsonism Hae-Won Shin and Sun Ju Chung J Clin Neurol. 2012 Mar; 8(1): 15–21
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persist or progress in 10-50% of patients…, the persistence of parkinsonism may be due to permanent DRBA-induced damage to dopamine receptors.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905632/
Persistent Drug-Induced Parkinsonism in Patients with Normal Dopamine Transporter Imaging Jin Yong Hong, Mun Kyung Sunwoo, Jungsu S. Oh, Jae Seung Kim, Young H. Sohn, and Phil Hyu Lee PLoS One. 2016; 11(6): e0157410.
Drug-induced parkinsonism (DIP) is commonly seen in movement disorder clinics… Up to 43% of them show normal activity of nigrostriatal neurons, suggesting that their parkinsonism is caused solely by the offending drugs (pure DIP)…, some DIP patients who have normal DAT activity show persistent parkinsonism after the cessation of the offending drug … Although the DAT imaging of these patients looks normal, the persistent symptoms may imply permanent damage in the dopaminergic pathway.
Drug-Induced Parkinsonism K.R.Chaudhuri, J.Nott (in Sethi ed. Drug-Induced Movement Disorders Dekker 2004)
In a proportion of cases with DIP, the condition may persist and some patients may develop idiopathic PD
Reports of Parkinson’s Disease Developing in Patients with a History of Reversible Drug-Induced Parkinsonism Rajput et al. (1982) Pathological evidence of nigral cell loss and Lewy bodies Goetz CG (1983) IPD developing 12–30 months DIP was reversed Stephens & Williamson (1984) 5 of 48 cases with DIP develop PD after mean 11 months (range 3–18 months) following recovery from DIP.
Marti Masso et al. (1991) Retrospective analysis of 72 DIP cases with 6 developing PD after an “asymptomatic period”
Gartmann et al. DIP (1993) developing in a cohort of patients with family history of PD
Study on Drug-Induced Parkinsonism and its Clinical Patterns in Eastern Indian Population Yadav, Praveen Kumar APIK Journal of Internal Medicine 11(1) 14-18, Jan–Mar 2023.
Drug-induced parkinsonism (DIP) is the second most common cause of parkinsonism after IPD. [Idiopathic Parkinson’s disease]… Thus, it becomes very important to check the medication list of any patient presenting with features of parkinsonism. …50% of the patients totally recovered from the DIP, 25% there was partial improvement, and 25% showed persistent symptoms
Parkinsonism has been described to persist in cases of DIP in up to 10–50% of cases despite withdrawal of the offending agent
DAT-SPECT (Dopamine Transporter Single Photon Emission Computed Tomography) imaging can be used to confirm that a patient has presynaptic dopaminergic deficiency and as such can distinguish patients with DIP, which is typically post-synaptic, from patients with PD [1,2]. …
At present there are no clear, established, practical guidelines for the use of DAT-SPECT as an ancillary study for the diagnosis of DIP.
Drug-induced Parkinsonism: A strong predictor of idiopathic Parkinson’s disease Sohyun Jeong, Hyemin Cho, Yun Joong Kim, Hyeo-Il Ma , Sunmee Jang PLOS ONE Published: March 1, 2021
…one theory supports some dopamine receptor blockers have direct toxic effects on neurons by inhibiting mitochondrial respiratory function and contribute to the irreversible cell death or pathway deficits in nigrostriatal dopamine area https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378786/
A Case of SSRI Induced Irreversible Parkinsonism S.Dixit, Shahbaj A Khan, and Sudip Azad J Clin Diagn Res. 2015 Feb; 9(2):
SSRI are known to cause reversible or irreversible motor disturbances through pathophysiological changes in basal ganglion motor system by altering the dopamine receptors postsynaptically…Case is reported to alert physicians to possibility of motor system damage while treating with SSRI.
Alonso A., Rodriguez L.A.G., Logroscino G., Hernan M.A. Use of antidepressants and the risk of Parkinson’s disease: a prospective study. J. Neurol. Neurosurg. Psychiatry. 2009;80:671–674
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