Síndrome Parkinsoniana por Drogas

da latrogenia Contingencial à Insuspeitada

Abstract

Since Delay and Deniker, in the eady fifties, introduced the neuroleptics for the treatment of psychosis, extrapyramidal secondary effects, mainly paddnsonian motor symptoms, have been well known to occur. Plastic muscle rigidity, bradykinesia, postural abnormalities, parkinsonian fascias, and, frequently, a rest tremor in the hands or even a fine, rapid, action and postural tremor, are common manifestations in patients receiving antipsychofic drugs. More recently, many new drugs have been introduced in the pharmacotherapy of many different diseases, which interfere in the dopaminergic brain pathways. Metochlopramide, sulpiride, tiapride, tetrabenazine and most of the neuroleptics acting post-synaptically, blocking the dopaminergic receptors or pre-synaptically, may produce the extrapyramidal reactions. Mare recently, flunarizine and cinarizine, two calcium channel blocking agents, which have been widely used as ivasoactive" drugs, useful against vertigo and dizziness and as antimigrainous prophylactic drugs, have been idenfied as responsible for numerous cases of parkinsonian syndromes accompanied by an intense apathy and depression. Occasionally, akathisia and tardive dyskinesia may also occur. Recently we studied 48 patients with a parkinsonian syndrome secondary to flunarizine and/or cinarizine utilization, comparing the clinical picture to that produced by other dopamine blocking agents. The results have been sent to be published elsewhere. Many of these cases receive the clinical diagnosis of Parkinson's disease and do not improve under proper medication.