Parkinson-like symptoms

Among the most significant adverse reactions associated with the antipsychotic dm are the extrapyramidal effects. The term extrapyramidal effects refers to a group of adverse reactions occurring on the extrapyramidal portion of the nervous system as a result of antipsychotic drains. This part of the nervous system affects body posture and promotes smooth and uninterrupted movement of various muscle groups. Antipsychotics disturb the function of the extrapyramidal portion of the nervous system, causing abnormal muscle movement. Extrapyramidal effects include Parkinson-like symptoms (see Chap. 29), akathisia, and dystonia (see Display 32-1). 

Extrapyramidal effects usually diminish with a reduction in the dosage of the antipsychotic drug. The primary health care provider may also prescribe an antiparkinsonism drug, such as benztropine (see Chap. 29) to reduce the incidence of Parkinson-like symptoms. 

The adverse reactions associated widi metoclopramide are usually mild. Higher doses or prolonged administration may produce central nervous system (CNS) symptoms, such as drowsiness, dizziness, Parkinson-like symptoms (tremor, mask-like facial expression, muscle rigidity), depression, facial grimacing, motor restlessness, and involuntary movements of die eyes, face, or limbs. Dexpandienol administration may cause itching, difficulty breadiing, and urticaria... 

Adverse reactions may include Hypersensitivity reactions parkinson-like symptoms hypotension or pain following IM injection blood dyscrasias blurred vision coma convulsions depression diarrhea disorientation dizziness drowsiness headache jaundice muscle cramps opisthotonos allergic-type skin reactions. 

Parkinson-like symptoms Parkinson-like symptoms have occurred, more commonly within the first 6 months after beginning treatment with metoclopramide but occasionally after longer periods. These symptoms generally subside within 2 to 3 months following discontinuance of metoclopramide. Give metoclopramide cautiously, if at all, to patients with preexisting Parkinson disease, because such patients may experience exacerbation of parkinsonian symptoms when taking... 

Most antipsychotics and especially the piperazines and the butyrophenones can cause extrapyra-midal symptoms. Blockade of dopamine receptors mainly in the corpus striatum is held responsible for these extrapyramidal effects. They may become manifest as a variety of clinical symptoms and it should be noted that within 24 8 hours after the beginning of treatment acute dystonic reactions like torticollis, facial grimacing and opisthotonos may occur. Parkinsonism-like symptoms such as bradyki-nesia, rigidity and tremor occur after weeks or months of therapy and are more common in the elderly. Motor restlessness, i.e. akathisia, also mostly occurs not before weeks or months after starting therapy. The tendency of an antipsychotic agent to produce extrapyramidal symptoms appears to be inversely related to its ability to block cholinergic receptors. 

Antiparkinsonism effects Because of anticholinergic property, some antagonists have significant suppressant effect on the parkinsonism like symptoms. 

The main side effects are GIT upset, headache, drowsiness, vertigo, visual disturbances and on prolonged use can produce parkinsonism like symptoms. In individuals with G-6-PD deficiency can cause haemolysis. 

Adverse effects. Fatigue, orthostatic hypotension, extrapyramidal Parkinson-like symptoms (p. 188), cutaneous reactions, hepatic damage, immune-hemolytic anemia. 

SCA17 also appears to be a risk factor for Parkinson-like symptoms (Lee et al., 2009). 

Excess—may result in Parkinson-like symptoms (shaking, slowness, stiffness) and psychosis. 

Locomotor activity and akinesia effects in the multidosed animals were, at least in part, a reflection of KCN-induced dopaminergic depletion, because each corresponded with decreased striatal dopamine activity (see also Persson, Cassel, Sellstrom, 1985). Furthermore, the addition of 1-DOPA reversed these effects on performance. Interestingly, 1-DOPA therapy has also successfully mitigated Parkinson-like symptoms in CN-exposed humans (Rosenow et al 1995 Uitti, Rajput, Ashenhurst, Rozdilsky, 1985). 

The three most recognized and widely used animal models for PD are the 6-OHDA and MPTP rat models, and the MPTP monkey model. Parkinson-like symptoms in rats can be produced by exposing one brain side to 6-OHDA, a toxic dopamine metabolite. After receiving a challenging dose of amphetamine, these animals exhibit rotational behavior which can be modified by anti-PD drugs. 

In the MPTP monkey model, like in humans, MPTP produces Parkinson-like symptoms that can be assessed by a modified Unified PD Rating Scale (UPDRS), the most commonly used tool for the evaluation of PD symptoms in humans. 

Although the drug is usually well tolerated in the elderly at low doses, sedation is not uncommon at higher doses. Parkinson-like symptoms can arise, presumably due to lowered central dopamine levels. The most serious potential hazard is psychic depression with suicidal tendencies. 

The highest brain concentrations of DA have been shown to be in the caudate nucleus. About two-thirds of the neurons in this structure respond to DA most are depressed by the transmitter, and a minority are excited. The caudate nucleus is a component of the extrapyramidal system that controls skeletal muscle. Of course, this fact relates to Parkinson s disease. Drugs that reduce dopaminergic functions by blocking DA receptors or in some other way interfere with DA may produce Parkinson-like symptoms as side effects, irrespective of what other activities they possess. This is what occurs with many antipsychotic drugs such as the phenothiazines. 

Other drugs for different spasticities include baclofen (this chapter, earlier), which is useful in multiple sclerosis and spinal cord trauma but not rheumatoid conditions the centrally acting orphenadrine (Chapter 8, Fig. 8-4) for Parkinson-like symptoms and the BZDs, particularly diazepam (considered later). 

Adverse effects are similar to those seen with tricyclic antidepressants. Additionally, dopamine-related effects, such as akathisia, galactorrhea/amenorrhea. and Parkinson-like symptoms are seen. 

TOXICITY Common dose-related side effects are G1 complaints (nausea, vomiting, and anorexia) and CNS effects (drowsiness, lethargy, euphoria, dizziness, headache, and hiccups) some tolerance to these effects develops. Parkinson-like symptoms and photophobia also have occurred. Restlessness, agitation, anxiety, aggressiveness, inability to concentrate, and other behavioral effects have occurred primarily in patients with a history of psychiatric disturbance. Urticaria and other skin reactions, including Stevens-Johnson syndrome, as well as systemic lupus erythematosus, eosinophilia, leukopenia, thrombocytopenia, pancytopenia, and aplastic anemia have been attributed to the drug, and deaths have resulted from bone marrow depression. 

Extrapyramidal symptoms, akathisia, dystonia, tardive dyskinesia, drowsiness, headache, dry mouth, orthostatic hypotension Agitation, dizziness, nervousness, akathisia, constipation, fever, weight gain Hypotension, postural hypotension, tardive dyskinesia, photophobia, urticaria, nasal congestion, dry mouth, akathisia, dystonia, pseudo parkin son ism, behavioral changes, headache, photosensitivity Parkinson-like symptoms, motor restlessness, dystonia, oculogyric aisis, tardive dyskinesia, dry mouth, diarrhea, headache, rash, drowsiness... 

Parkinson-like symptoms developed in a patient taking amitriptyline and flupenthixol when fluoxetine was given. ... 

Ritonavir, and possibly indinavir, are predicted to reduce the metabolism of huspirone. A single case report describes Parkinson-like symptoms attributed to concurrent use of huspirone with ritonavir and also possibly indinavir. 

An isolated report describes severe Parkinson-like symptoms when a woman with Huntington s chorea was given tetrabenazine and chlorpromazine. 

Symptoms of Exposure Dizziness, headache, poor sleep, fatigue, nervousness anorexia, weight loss psychosis polyneuropathy Parkinson-like symptoms ocular changes cardiovascular system irregularity gastrointestinal discomfort bums, dermatitis. Contact with skin causes burning pain, eiythema and exfoliation. 

Nervous system In one case a high dose of octreotide may have altered the balance between brain dopamine and GABA, and thus caused Parkinson-like symptoms [35" ]. 

Tricyclic compounds with a seven embered central ring - A dlbenzo-dlazepine, clozapine (J+, HF-l85 ), was effective in psychotic patients however, it produced neither neuroleptic-like (e.g., catalepsy, antiemetic) actions in animals nor parkinsonism-like symptoms in man. A derivative of dibenzthlepin, 6P 5795 (5a), was more potent than chlorpromazlne in various animal tests for neuroleptic activity and it antagonized amphetamine- and tetrabenazlne-lnduced responses. Clinically, Improved... 

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