Your brain can’t possibly do that

That was my GP’s reaction when I told him what was happening in my right arm. I told him I had been on the phone holding it up to my ear with my right hand and had felt pins & needles in my arm. Typical sign of hyperventilation he said. I don’t think so. Another time it happened when I was just I was lying quietly on the floor about to start my yoga. Some months later I was sitting at gp surgery and I could feel a tingling going down my right arm. I remember

getting a bit tearful. I knew something was happening but I had no idea what.

My right arm continues to be the worst affected side for stiffness, tremor and dystonia/dyskinesia. The pins and needles started a couple of months after my GP gave me antidepressants (Sertraline 13 days, Amitriptyline 2 days). I get pins and needles in both hands too. It can be pretty uncomfortable so I have to stop what I’m doing and shake

it out.

Kings PD Pain questionaire: Radicular pain 14.Shooting pain/pins and needles down the limbs

UK Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria (Hughes AJ et al. J Neurol Neurosurg Psychiatry 1992;55:181-4)

Supportive criteria includes ‘Unilateral onset’ and ‘Persistent asymmetry affecting side of onset most’

Below are some case reports I found of Sertraline causing Parkinsonism, sometimes it is not reversible:

Parkinsonism secondary to the use of sertraline Cano A, Roquer J.Med Clin (Barc). 1995 Dec 8;105(20):797-8.

Extrapyramidal disorders following sertraline use; experiences with a new selective antidepressant Kolling P, Jansen Steur EN, de Burlet HM. Ned Tijdschr Geneeskd. 1996 Jul 13;140(28):1467-8.

Reversible parkinsonism in a 90-year-old man taking sertraline. Schechter DS, Nunes EV. J Clin Psychiatry. 1997 Jun;58(6):275.

Reversible parkinsonism secondary to the use of sertraline P.Latorre, Z Lopez Neurologia 1998 Nov;13(9)444-5

Sertraline induced parkinsonism. A case report and in-vivo study of the effect of sertraline on dopamine metabolism Di Rocco A, Brannan T, Prikhojan A, et al:. J Neural Transm 1998; 105: 247–251

These data indicate that sertraline has an effect on dopamine metabolism, which may alter function in the striatum and induce a parkinsonian syndrome.

SSRI-induced parkinsonism may be an early sign of future Parkinson’s Disease. Gonul AS, Aksu M J Clin Psychiatry 1999; 60:410

Parkinsonism and Parkinson’s disease associated with long-term administration of sertraline. Pina Latorre MA, Modrego PJ, Rodilla F, Catalán C, Calvo M. J Clin Pharm Ther. 2001 Apr;26(2):111-2.

Can Sertraline Induce Parkinson’s Disease? R. J. Gregory & J. F. White Psychosomatics 42:163-164, April 2001

Sertraline: Parkinsonism in an elderly patient: case report Reactions , Vol,1, Number 861, 2001

Parkinsonism and Elevated Lactic Acid With Sertraline DN Mendhekar, RP Benuiwal, V Puri The Canadian Journal of Psychiatry April 2005

A Case of SSRI Induced Irreversible Parkinsonism Siddharth Dixit, Shahbaj A Khan, and Sudip Azad J Clin Diagn Res. 2015 Feb; 9(2): VD01–VD02.

SSRI are known to cause reversible or irreversible motor disturbances through pathophysiological changes in basal ganglion motor system by altering the dopamine receptors postsynaptically.

Review of case reports related to SSRI induced EPS revealed akathisia (45.1%) followed by dystonic reactions (28.2%), parkinsonism (14.1%) and tardive dyskinesia (11.3%).

Before I was finally diagnosed I had been suffering terrible pains and needles. I had asked if any medication I was taking could be responsible as I hadn’t long started taking amlodipine. I was told this couldn’t be the cause. A year or so later I was then told that anecdotally there were reports of amlodipine causing pins and needles. My gp prescived me another blood pressure med and lo and behold pins and needles reduced considerably.

I googled ‘amlodipine drug-induced parkinsonism’ and found the following comment from a former neuro-nurse:

“I’m afraid doctors can be very reluctant to admit to the side-effects of medications, and may not even know the rarer ones.”

Medical Editor: John P. Cunha, DO, FACOEP Last reviewed on RxList 12/21/2018

Norvasc Professional Information SIDE EFFECTS Central and Peripheral Nervous System:

hypoesthesia, neuropathy peripheral, paresthesia, tremor, vertigo.

[Paresthesia: An abnormal sensation of the body, such as numbness, tingling, or burning.]

Medication Guide

PATIENT INFORMATION NORVASC® (amlodipine besylate) 2.5-mg, 5-mg, and 10-mg Tablets

muscle rigidity, tremor and/or abnormal muscle movement

Parkinsonian syndrome induced by amlodipine: Case Report Hélio A.G. Teive , Francisco M.B. Germiniani, Lineu César Werneck Mov Disord. 2002 Jul;17(4):833-5.

An elderly patient who developed marked symptoms of parkinsonism in response to amlodipine for the treatment of arterial systemic hypertension is described. She had a complete reversal of her motor symptoms after discontinuation of the drug.

Drug-induced parkinson syndromes Nguyen N, Pradel V, Micallef J, Montastruc JL, Blin O. Therapie. 2004 Jan-Feb;59(1):105-12.

Parkinsonism is defined by the association of akinesia with one of the following symptoms: extrapyramidal rigidity, tremor at rest, or postural instability.

A drug-induced aetiology must always be suspected when parkinsonian symptoms appear, or increase in a patient receiving drug treatment. Indeed drug-induced is the more frequent aetiology of secondary parkinsonism.

The main treatments involved are antipsychotic and other neuroleptic drugs (accounting for up to two-thirds of drug-induced parkinsonism), and calcium-channel entry blockers.

Drug Induced Parkinsonism: An Overview Bahiya Sulthana and Sujith Ovallath James Parkinson’s Research Centre, Kannur Medical College, India Open Access J Neurol Neurosurg 3(4): OAJNN.MS.ID.555620 (2017)

Idiopathic Parkinson’s disease (iPD) vs Drug induced Parkinsonism

Over the time biggest challenge encountered in DIP is to differentiate it from iPD.

Any patient presenting to out-patient department with symptoms suggestive of Parkinsonism syndrome should undergo detailed history about medication taken during past year.

Drug-induced parkinsonism: a review of 17 years’ experience in a regional pharmacovigilance center in France.

Bondon-Guitton E, Perez-Lloret S, Bagheri H, Brefel C, Rascol O, Montastruc JL. Mov Disord. 2011 Oct;26(12):2226-31.

Among the 261 suspect drugs, most involved central dopaminergic antagonists (49%), followed by antidepressants (8%), calcium channel blockers (5%), peripheral dopaminergic antagonists (5%), and H1 antihistamines (5%). Cases with lithium, valproic acid, amiodarone, anticholinesterases, or trimetazidine were also found.

There were two main peaks of occurrence for parkinsonian symptoms after drug introduction:

The first peak (69% of the notifications) occurred within the first 3 months and mainly involved (central or peripheral) dopaminergic antagonists or antidepressants;

the second peak (20% of the notifications) occurred after 12 months of treatment and mainly involved calcium channel blockers

@Appletree. V interesting. I am confident in the diagnosis of PD but the pins and needles and other things meant that for a time MS was being considered and so delayed my diagnosis considerably.