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Secondary parkinsonism

Secondary parkinsonism is similar to Parkinson disease .  But the symptoms are caused by certain medicines, a different nervous system disorder, or another illness.

Parkinsonism refers to any condition that involves the types of movement problems seen in Parkinson disease. These problems include tremors, slow movement, and stiffness of the arms and legs.

Alternative Names

Parkinsonism - secondary; Atypical Parkinson disease

Causes

Secondary parkinsonism may be caused by health problems, including:

Other causes of secondary parkinsonism include:

  • Brain damage caused by anesthesia drugs (such as during surgery)
  • Carbon monoxide poisoning
  • Certain medicines used to treat mental disorders or nausea
  • Mercury poisoning and other chemical poisonings
  • Overdoses of narcotics
  • MPTP (a contaminant in some street drugs)

There have been cases of secondary parkinsonism among IV drug users who injected a substance called MPTP, which can be produced when making a form of heroin. These cases are rare and have mostly affected long-term drug users.

Symptoms

Common symptoms include:

  • Decrease in facial expressions
  • Difficulty starting and controlling movement
  • Loss or weakness of movement (paralysis)
  • Soft voice
  • Stiffness of the trunk, arms, or legs

Confusion and memory loss may be likely in secondary parkinsonism. This is because the diseases that cause secondary parkinsonism often lead to dementia .

Exams and Tests

The health care provider will perform a physical exam and ask questions about the person's medical history and symptoms. Be aware that the symptoms may be hard to assess, particularly in the elderly.

Examination may show:

  • Difficulty starting or stopping voluntary movements
  • Tense muscles
  • Problems with posture
  • Slow, shuffling walk
  • Tremors (shaking)

Reflexes are usually normal.

Tests may be ordered to confirm or rule out other problems that can cause similar symptoms.

Treatment

If the condition is caused by a medicine, the doctor may recommend changing or stopping the medicine.

Treating underlying conditions such as stroke or infections can reduce symptoms.

If symptoms make it hard to do everyday activities, the doctor may recommend medicine. Medicines used to treat this condition can cause severe side effects. It is important to see the doctor for check-ups. Secondary parkinsonism tends to be less responsive to medical therapy than Parkinson's disease.

Outlook (Prognosis)

Unlike Parkinson disease, secondary parkinsonism may stabilize or even improve if the underlying cause is treated. Brain problems, such as Lewy body disease, are not reversible.

Possible Complications

  • Difficulty doing daily activities
  • Difficulty swallowing (eating)
  • Disability (varying degrees)
  • Injuries from falls
  • Side effects of medications used to treat the condition

Side effects from loss of strength (debilitation):

When to Contact a Medical Professional

Call the health care provider if:

  • Symptoms of secondary parkinsonism develop, come back, or get worse
  • New symptoms appear, including confusion, movements that cannot be controlle
  • You are unable to care for the person at home after treatment starts

Prevention

Treating conditions that cause secondary parkinsonism may decrease the risk.

People taking medicines that can cause secondary parkinsonism should be carefully monitored by the doctor to prevent the condition from developing.

References

Lang AE. Parkinsonism. In: Goldman L, Schafer AI. Goldman’s Cecil Textbook of Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 416.

Robottom BJ, Shulman LM, Weiner WJ. Drug-induced movement disorders: Emergencies and management. Neurol Clin. 2012;30:309–320.

Updated: 9/25/2013

Joseph V. Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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