Balcerzak Wiktoria, Gorzkowska Agnieszka, Konieczna Marta, Blach Anna, Lasek-Bal Anetta
Department of Neurology, Upper-Silesian Medical Center, Medical University of Silesia, Katowice, POL.
Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, POL.
Cureus. 2025 Jul 17;17(7):e88177. doi: 10.7759/cureus.88177. eCollection 2025 Jul.
Drug-induced parkinsonism (DIP) is the second most common cause of parkinsonian syndromes after idiopathic Parkinson's disease (iPD), accounting for approximately 15-25% of cases in older adults. While DIP typically results from antipsychotic-induced dopamine receptor blockade and is often reversible, iPD is a progressive neurodegenerative disorder characterized by asymmetrical onset, resting tremor, and good response to levodopa. Distinguishing between these conditions is clinically important but often challenging. The aim of this article is to discuss the diagnostic and therapeutic challenges involved in differentiating DIP from iPD in patients with psychiatric disorders who are chronically treated with antipsychotics. Based on the case of a 52-year-old man with a long-standing history of schizophrenia treatment, the diagnostic process and clinical manifestations leading to the final diagnosis are presented. The patient developed Parkinsonian symptoms during olanzapine therapy, initially suggesting DIP. This paper discusses the clinical indicators differentiating DIP from iPD, as well as the critical role of single photon emission computed tomography (SPECT) with ioflupane-123 (DaTSCAN) in the differential diagnosis of Parkinsonism in selected, ambiguous cases. The described case illustrates the phenomenon of so-called "unmasked Parkinson's disease" and highlights the need for detailed neurological monitoring in patients suspected of having DIP. It is essential to consider iPD as an independent cause of movement disorders in patients treated with antipsychotics. Early diagnosis and appropriate treatment of the underlying cause of Parkinsonism can significantly reduce extrapyramidal symptoms and improve the patient's quality of life.
药物性帕金森综合征（DIP）是继特发性帕金森病（iPD）之后帕金森综合征的第二大常见病因，约占老年患者病例的15%-25%。虽然DIP通常由抗精神病药物引起的多巴胺受体阻滞所致，且往往是可逆的，但iPD是一种进行性神经退行性疾病，其特征为起病不对称、静止性震颤以及对左旋多巴反应良好。区分这两种情况在临床上很重要，但往往具有挑战性。本文旨在探讨在长期接受抗精神病药物治疗的精神疾病患者中，鉴别DIP和iPD所涉及的诊断和治疗挑战。基于一名有长期精神分裂症治疗史的52岁男性病例，介绍了导致最终诊断的诊断过程和临床表现。该患者在奥氮平治疗期间出现帕金森症状，最初提示为DIP。本文讨论了区分DIP和iPD的临床指标，以及123I-碘氟潘（DaTSCAN）单光子发射计算机断层扫描（SPECT）在部分疑难帕金森综合征病例鉴别诊断中的关键作用。所描述的病例说明了所谓“隐匿性帕金森病”现象，并强调了对疑似患有DIP的患者进行详细神经学监测的必要性。在接受抗精神病药物治疗的患者中，将iPD视为运动障碍的独立病因至关重要。帕金森综合征潜在病因的早期诊断和适当治疗可显著减轻锥体外系症状，提高患者生活质量。
