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| {{CMG}} | | {{CMG}} |
| {{SK}} Parkinson's syndrome; atypical Parkinson's; secondary Parkinson's | | {{SK}} Parkinson's syndrome; atypical Parkinson's; secondary Parkinson's |
| ==Overview== | | ==[[Parkinsonism overview|Overview]]== |
| '''Parkinsonism''' is a neurological [[syndrome]] characterized by [[tremor]], [[hypokinesia]], [[spasticity|rigidity]], and [[balance disorder|postural instability]].<ref name=Aminoff_2005>{{cite book | author = Aminoff MJ, Greenberg DA, Simon RP | title = Clinical Neurology | publisher = Lange: McGraw-Hill Medical | edition = 6th ed. | pages = 241–5 |year = 2005 | isbn = 0071423605 }}</ref> The underlying causes of parkinsonism are numerous, and diagnosis can be complex.<ref>{{cite journal | author = Tuite PJ, Krawczewski K | title = Parkinsonism: a review-of-systems approach to diagnosis | journal = Seminars in neurology | volume = 27 | issue = 2 | pages = 113-22 | year = 2007 | pmid = 17390256 | doi = 10.1055/s-2007-971174}}</ref> While the [[neurodegenerative]] condition [[Parkinson's disease]] (PD) is the most common cause of parkinsonism, a wide-range of other [[Etiology|etiologies]] can lead to a similar set of symptoms, including some [[toxins]], a few [[metabolic disease]]s, and a handful of non-PD neurological conditions.<ref>{{cite journal | author = Christine CW, Aminoff MJ | title = Clinical differentiation of parkinsonian syndromes: prognostic and therapeutic relevance | journal = Am. J. Med. | volume = 117 | issue = 6 | pages = 412-9 | year = 2004 | pmid = 15380498 | doi = 10.1016/j.amjmed.2004.03.032}}</ref> Its most common cause is as a side effect of medications, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupenthixol and zuclopenthixol) and butyrophenones (such as haloperidol (Haldol)), piperazines (such as ziprasidone), and rarely, antidepressants.
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| ==Differential Diagnosis== | | ==[[Parkinsonism historical perspective|Historical Perspective]]== |
| If PD has been excluded, the [[differential diagnosis]] or list of potential causes for this syndrome includes:
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| * [[AIDS]] can sometimes lead to the symptoms of Parkinson's disease, due to commonly causing dopaminergic dysfunction.<ref>{{cite journal | author = Tse W, Cersosimo MG, Gracies JM, ''et al'' | title = Movement disorders and AIDS: a review | journal = Parkinsonism Relat. Disord. | volume = 10 | issue = 6 | pages = 323-34 | year = 2004 | pmid = 15261874 | doi = 10.1016/j.parkreldis.2004.03.001}}</ref>
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| * [[Corticobasal degeneration]]<ref name=Aminoff_2005/>
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| * [[Creutzfeldt-Jakob disease]]<ref>{{cite journal | author = Maltête D, Guyant-Maréchal L, Mihout B, Hannequin D | title = Movement disorders and Creutzfeldt-Jakob disease: a review | journal = Parkinsonism Relat. Disord. | volume = 12 | issue = 2 | pages = 65-71 | year = 2006 | pmid = 16364674 | doi = 10.1016/j.parkreldis.2005.10.004}}</ref>
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| * [[Diffuse Lewy body disease]]<ref name=Aminoff_2005 />
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| * Drug-induced parkinsonism (due to drugs such as [[antipsychotics]], [[metoclopramide]], [[MPTP]]<ref name=Watanabe_2005>{{cite journal | author = Watanabe Y, Himeda T, Araki T | title = Mechanisms of MPTP toxicity and their implications for therapy of Parkinson's disease | journal = Med. Sci. Monit. | volume = 11 | issue = 1 | pages = RA17-23 | year = 2005 | pmid = 15614202 | url = http://www.medscimonit.com/pub/vol_11/no_1/5333.pdf | format = PDF}}</ref>)<ref name=Aminoff_2005/>
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| * [[Encephalitis lethargica]]<ref name=Aminoff_2005/>
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| * [[Multiple system atrophy]]<ref>{{cite journal | author = Wenning GK, Geser F | title = Multiple system atrophy | journal = Rev. Neurol. (Paris) | volume = 159 | issue = 5 Pt 2 | pages = 3S31-8 | year = 2003 | pmid = 12773886 | doi = }}</ref>
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| * [[Pantothenate kinase-associated neurodegeneration]] (Hallervorden-Spatz syndrome)<ref name=Uc_2003>{{cite journal | author = Uc EY, Rodnitzky RL | title = Childhood dystonia | journal = Seminars in pediatric neurology | volume = 10 | issue = 1 | pages = 52-61 | year = 2003 | pmid = 12785748 | doi = | doi = 10.1016/S1071-9091(02)00010-4 <!--Retrieved from CrossRef by DOI bot-->}}</ref>
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| * [[Progressive supranuclear palsy]]<ref name=Aminoff_2005 />
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| * Toxicity due to substances such as [[carbon monoxide]],<ref name=Harrison>{{cite book | author = DeLong MR, Juncos JL | title = Parkinson's Disease and Other Movement Disorders. ''In:'' Harrison's Principles of Internal Medicine | pages = p. 2414 | edition = 16th ed.| publisher = McGraw-Hill Professional | year = 2004 | isbn = 0-07-140235-7 }}</ref> [[carbon disulfide]],<ref name=Harrison/> [[Manganism|manganese]],<ref name=Harrison/> [[paraquat]],<ref>{{cite journal |author=Dinis-Oliveira RJ, Remião F, Carmo H, ''et al'' |title=Paraquat exposure as an etiological factor of Parkinson's disease |journal=Neurotoxicology |volume=27 |issue=6 |pages=1110-22 |year=2006 |pmid=16815551 |doi=10.1016/j.neuro.2006.05.012}}</ref> [[hexane]], [[rotenone]], and [[toluene]].
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| * Vascular parkinsonism<ref>{{cite journal | author = Thanvi B, Lo N, Robinson T | title = Vascular Parkinsonism--an important cause of parkinsonism in older people | journal = Age and ageing | volume = 34 | issue = 2 | pages = 114-9 | year = 2005 | pmid = 15713855 | doi = 10.1093/ageing/afi025 | url = http://ageing.oxfordjournals.org/cgi/reprint/34/2/114 | format = PDF}}</ref>
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| * [[Wilson's disease]] is a genetic disorder in which there is an abnormal accumulation of copper. The excess copper can lead to the formation of a copper-dopamine complex, which leads to the oxidation of dopamine to aminochrome.<ref>{{cite journal |author=Członkowska A, Tarnacka B, Möller JC, ''et al'' |title=Unified Wilson's Disease Rating Scale - a proposal for the neurological scoring of Wilson's disease patients |journal=Neurol. Neurochir. Pol. |volume=41 |issue=1 |pages=1-12 |year=2007 |pmid=17330175 |doi=}}</ref>
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| * [[Paraneoplastic syndrome]]. Neurological symptoms caused by antibodies associated with various cancers.
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| ==References== | | ==[[Parkinsonism pathophysiology|Pathophysiology]]== |
| {{Reflist|2}}
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| | ==[[Parkinsonism causes|Causes]]== |
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| | ==[[Parkinsonism differential diagnosis|Differentiating Parkinsonism from other Diseases]]== |
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| | ==[[Parkinsonism epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[Parkinsonism risk factors|Risk Factors]]== |
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| | ==[[Parkinsonism natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| | ==Diagnosis== |
| | [[Parkinsonism history and symptoms|History and Symptoms]] | [[Parkinsonism physical examination|Physical Examination]] |[[Parkinsonism laboratory findings|Laboratory Findings]] | [[Parkinsonism CT|CT]] | [[Parkinsonism MRI|MRI]] | [[Parkinsonism other imaging findings|Other Imaging Findings]] |[[Parkinsonism other diagnostic studies|Other Diagnostic Studies]] |
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| | ==Treatment== |
| | [[Parkinsonism medical therapy|Medical Therapy]] | [[Parkinsonism surgery|Surgery]] | [[Parkinsonism primary prevention|Primary Prevention]] | [[Parkinsonism secondary prevention|Secondary Prevention]] | [[Parkinsonism cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Parkinsonism future or investigational therapies|Future or Investigational Therapies]] |
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| | == Case Studies == |
| | [[Parkinsonism case study one|Case #1]] |
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| [[pt:Parkinsonismo]] | | [[pt:Parkinsonismo]] |