Parkinsonism

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Parkinsonism
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Causes

Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia (slowed movements), rigidity, and postural instability. [1] [2] Both hypokinetic (bradykinesia and akinesia) as well as hyperkinetic (cogwheel rigidity and tremors at rest) features are displayed by Parkinsonism. [3] These are the four motor symptoms found in Parkinson's disease (PD) –after which it is named – dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and many other conditions. This set of symptoms occurs in a wide range of conditions and may have many causes, including neurodegenerative conditions, drugs, toxins, metabolic diseases, and neurological conditions other than PD. [4]

Contents

Signs and symptoms

Parkinsonism is a clinical syndrome characterized by the four motor symptoms found in Parkinson's disease: tremor, bradykinesia (slowed movements), rigidity, and postural instability. [1] [2]

Parkinsonism gait problems can lead to falls and serious physical injuries. Other common symptoms include:

Conditions

Parkinsonism occurs in many conditions.

Neurological

Neurodegenerative conditions and Parkinson-plus syndromes that can cause parkinsonism include: [6]

Infectious

Toxins

Evidence exists to show a link between exposure to pesticides and herbicides and PD; a two-fold increase in risk was seen with paraquat or maneb/mancozeb exposure. [12]

Chronic manganese (Mn) exposure has been shown to produce a parkinsonism-like illness characterized by movement abnormalities. [13] This condition is not responsive to typical therapies used in the treatment of PD, suggesting an alternative pathway than the typical dopaminergic loss within the substantia nigra. [13] Manganese may accumulate in the basal ganglia, leading to the abnormal movements that characterize parkinsonism. [14] A mutation of the SLC30A10 gene, a manganese efflux transporter necessary for decreasing intracellular Mn, has been linked with the development of this parkinsonism-like disease. [15] The Lewy bodies typical to PD are not seen in Mn-induced parkinsonism. [14]

Agent Orange may be a cause of parkinsonism, although evidence is inconclusive and further research is needed. [16]

Other toxins that have been associated with parkinsonism are:

Vascular

Other

Differential diagnosis

Secondary parkinsonism, including vascular parkinsonism and drug-induced parkinsonism. [35] [36]

Drug-induced parkinsonism

About 7% of people with parkinsonism developed symptoms as a result of side effects of medication, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupentixol and zuclopenthixol) and butyrophenones (such as haloperidol), and rarely, antidepressants. Yet another drug that can induce parkinsonism is the antihistaminic medication cinnarizine, usually prescribed for motion sickness; this is because besides antagonizing histamine receptors this drug antagonizes the dopamine D2 receptors. [37] The incidence of drug-induced parkinsonism increases with age. Drug-induced parkinsonism tends to remain at its presenting level and does not worsen like Parkinson's disease. [38]

Implicated medications include:

Society and culture

In the United States, the 2021 National Defense Authorization Act (NDAA) added parkinsonism to the list of presumptive conditions associated with Agent Orange exposure, enabling affected service members to receive Veterans Affairs disability benefits. [42]  

Related Research Articles

<span class="mw-page-title-main">Deep brain stimulation</span> Neurosurgical treatment involving implantation of a brain pacemaker

Deep brain stimulation (DBS) is a surgical procedure that implants a neurostimulator and electrodes which sends electrical impulses to specified targets in the brain responsible for movement control. The treatment is designed for a range of movement disorders such as Parkinson's disease, essential tremor, and dystonia, as well as for certain neuropsychiatric conditions like obsessive-compulsive disorder (OCD) and epilepsy. The exact mechanisms of DBS are complex and not entirely clear, but it is known to modify brain activity in a structured way.

<span class="mw-page-title-main">Dystonia</span> Neurological movement disorder

Dystonia is a neurological hyperkinetic movement disorder in which sustained or repetitive muscle contractions occur involuntarily, resulting in twisting and repetitive movements or abnormal fixed postures. The movements may resemble a tremor. Dystonia is often intensified or exacerbated by physical activity, and symptoms may progress into adjacent muscles.

Dyskinesia refers to a category of movement disorders that are characterized by involuntary muscle movements, including movements similar to tics or chorea and diminished voluntary movements. Dyskinesia can be anything from a slight tremor of the hands to an uncontrollable movement of the upper body or lower extremities. Discoordination can also occur internally especially with the respiratory muscles and it often goes unrecognized. Dyskinesia is a symptom of several medical disorders that are distinguished by their underlying cause.

<span class="mw-page-title-main">Hyperkinesia</span> Excessive movements due to basal ganglia dysfunction

Hyperkinesia refers to an increase in muscular activity that can result in excessive abnormal movements, excessive normal movements, or a combination of both. Hyperkinesia is a state of excessive restlessness which is featured in a large variety of disorders that affect the ability to control motor movement, such as Huntington's disease. It is the opposite of hypokinesia, which refers to decreased bodily movement, as commonly manifested in Parkinson's disease.

<span class="mw-page-title-main">Progressive supranuclear palsy</span> Medical condition

Progressive supranuclear palsy (PSP) is a late-onset neurodegenerative disease involving the gradual deterioration and death of specific volumes of the brain. The condition leads to symptoms including loss of balance, slowing of movement, difficulty moving the eyes, and cognitive impairment. PSP may be mistaken for other types of neurodegeneration such as Parkinson's disease, frontotemporal dementia and Alzheimer's disease. The cause of the condition is uncertain, but involves the accumulation of tau protein within the brain. Medications such as levodopa and amantadine may be useful in some cases.

<span class="mw-page-title-main">Hypokinesia</span> Decreased movement due to basal ganglia dysfunction

Hypokinesia is one of the classifications of movement disorders, and refers to decreased bodily movement. Hypokinesia is characterized by a partial or complete loss of muscle movement due to a disruption in the basal ganglia. Hypokinesia is a symptom of Parkinson's disease shown as muscle rigidity and an inability to produce movement. It is also associated with mental health disorders and prolonged inactivity due to illness, amongst other diseases.

Parkinson-plus syndromes (PPS) are a group of neurodegenerative diseases featuring the classical features of Parkinson's disease with additional features that distinguish them from simple idiopathic Parkinson's disease (PD). Parkinson-plus syndromes are either inherited genetically or occur sporadically.

<span class="mw-page-title-main">Corticobasal degeneration</span> Rare neurodegenerative disease

Corticobasal degeneration (CBD) is a rare neurodegenerative disease involving the cerebral cortex and the basal ganglia. CBD symptoms typically begin in people from 50 to 70 years of age, and typical survival before death is eight years. It is characterized by marked disorders in movement and cognition, and is classified as one of the Parkinson plus syndromes. Diagnosis is difficult, as symptoms are often similar to those of other disorders, such as Parkinson's disease, progressive supranuclear palsy, and dementia with Lewy bodies, and a definitive diagnosis of CBD can only be made upon neuropathologic examination.

Extrapyramidal symptoms (EPS) are symptoms that are archetypically associated with the extrapyramidal system of the brain's cerebral cortex. When such symptoms are caused by medications or other drugs, they are also known as extrapyramidal side effects (EPSE). The symptoms can be acute (short-term) or chronic (long-term). They include movement dysfunction such as dystonia, akathisia, parkinsonism characteristic symptoms such as rigidity, bradykinesia, tremor, and tardive dyskinesia. Extrapyramidal symptoms are a reason why subjects drop out of clinical trials of antipsychotics; of the 213 (14.6%) subjects that dropped out of one of the largest clinical trials of antipsychotics, 58 (27.2%) of those discontinuations were due to EPS.

<span class="mw-page-title-main">Frontotemporal dementia and parkinsonism linked to chromosome 17</span> Medical condition

Frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP-17) is an autosomal dominant neurodegenerative tauopathy and Parkinson plus syndrome. FTDP-17 is caused by mutations in the MAPT gene located on the q arm of chromosome 17, and has three cardinal features: behavioral and personality changes, cognitive impairment, and motor symptoms. FTDP-17 was defined during the International Consensus Conference in Ann Arbor, Michigan, in 1996.

<span class="mw-page-title-main">Central nervous system disease</span> Disease of the brain or spinal cord

Central nervous system diseases or central nervous system disorders are a group of neurological disorders that affect the structure or function of the brain or spinal cord, which collectively form the central nervous system (CNS). These disorders may be caused by such things as infection, injury, blood clots, age related degeneration, cancer, autoimmune disfunction, and birth defects. The symptoms vary widely, as do the treatments.

Pleurothotonus, commonly known as Pisa syndrome, is a rare neurological disorder which occurs due to prolonged exposure to antipsychotic drugs. It is characterized by dystonia, and abnormal and sustained involuntary muscle contraction. This may cause twisting or jerking movements of the body or a body part. Although Pisa syndrome develops most commonly in those undergoing long-term treatment with antipsychotics, it has been reported less frequently in patients receiving other medications, such as an acetylcholinesterase inhibitor. However, it has also been seen in those with other diseases causing neurodegeneration and in those who are not receiving any medication. The characteristic development of Pisa syndrome consists of two types of dystonia: acute dystonia and tardive dystonia. The underlying pathology of drug-induced Pisa syndrome is very complex, and development may be due to an underlying dopaminergic-cholinergic imbalance, or serotonergic/noradrenergic dysfunction.

Myoclonic dystonia or Myoclonus dystonia syndrome is a rare movement disorder that induces spontaneous muscle contraction causing abnormal posture. The prevalence of myoclonus dystonia has not been reported, however, this disorder falls under the umbrella of movement disorders which affect thousands worldwide. Myoclonus dystonia results from mutations in the SGCE gene coding for an integral membrane protein found in both neurons and muscle fibers. Those suffering from this disease exhibit symptoms of rapid, jerky movements of the upper limbs (myoclonus), as well as distortion of the body's orientation due to simultaneous activation of agonist and antagonist muscles (dystonia).

<span class="mw-page-title-main">Parkinson's disease</span> Long-term neurodegenerative disease

Parkinson's disease (PD), or simply Parkinson's, is a long-term neurodegenerative disease of mainly the central nervous system that affects both the motor system and non-motor systems. The symptoms usually emerge slowly, and as the disease progresses, non-motor symptoms become more common. Usual symptoms are tremor, slowness of movement, rigidity, and difficulty with balance, collectively known as parkinsonism. Parkinson's disease dementia, falls and neuropsychiatric problems such as sleep abnormalities, psychosis, mood swings, or behavioral changes may arise in advanced stages.

<span class="mw-page-title-main">Signs and symptoms of Parkinson's disease</span> Signs and symptoms

Signs and symptoms of Parkinson's disease are varied. Parkinson's disease affects movement, producing motor symptoms. Non-motor symptoms, which include dysautonomia, cognitive and neurobehavioral problems, and sensory and sleep difficulties, are also common. When other diseases mimic Parkinson's disease, they are categorized as parkinsonism.

<span class="mw-page-title-main">Kufor–Rakeb syndrome</span> Medical condition

Kufor–Rakeb syndrome (KRS) is an autosomal recessive disorder of juvenile onset also known as Parkinson disease-9 (PARK9). It is named after Kufr Rakeb in Irbid, Jordan. Kufor–Rakeb syndrome was first identified in this region in Jordan with a Jordanian couple's 5 children who had rigidity, mask-like face, and bradykinesia. The disease was first described in 1994 by Najim Al-Din et al. The OMIM number is 606693.

Corticobasal syndrome (CBS) is a rare, progressive atypical Parkinsonism syndrome and is a tauopathy related to frontotemporal dementia. CBS is typically caused by the deposit of tau proteins forming in different areas of the brain.

Dopamine transporter deficiency syndrome (DTDS), also known as infantile parkinsonism-dystonia, is a rare movement disorder that causes progressively worsening dystonia and parkinsonism. It is the first known inherited dopamine 'transportophathy.'

Rapid eye movement sleep behaviour disorder and Parkinson's disease is rapid eye movement sleep behavior disorder (RBD) that is associated with Parkinson's disease. RBC is linked genetically and neuropathologically to α- synuclein, a presynaptic neuronal protein that exerts deleterious effects on neighbouring proteins, leading to neuronal death. This pathology is linked to numerous other neurodegenerative disorders, such as Lewy body dementias, and collectively these disorders are known as synucleinopathies. Numerous reports over the past few years have stated the frequent association of synucleinopathies with REM sleep behaviour disorder (RBD). In particular, the frequent association of RBD with Parkinson's. In the general population the incidence of RBD is around 0.5%, compared to the prevalence of RBD in PD patients, which has been reported to be between 38% and 60%. The diagnosis and symptom onset of RBD typically precedes the onset of motor or cognitive symptoms of PD by a number of years, typically ranging anywhere from 2 to 15 years prior. Hence, this link could provide an important window of opportunity in the implementation of therapies and treatments, that could prevent or slow the onset of PD.

<span class="mw-page-title-main">Adaptive Deep Brain Stimulation</span> Neurosurgical treatment involving implantation of an adaptive neurostimularot

Adaptive Deep Brain Stimulation (aDBS), also known as Closed Loop Deep Brain stimulation (clDBS), is a neuro-modulatory technique currently under investigation for the treatment of neurodegenerative diseases.

References

  1. 1 2 3 Aminoff MJ, Greenberg DA, Simon RP (2005). "Chapter 7: Movement disorders". Clinical Neurology (6th ed.). Lange: McGraw-Hill Medical. pp. 241–45. ISBN   978-0-07-142360-1.
  2. 1 2 Ogawa T, Fujii S, Kuya K, Kitao SI, Shinohara Y, Ishibashi M, et al. (September 2018). "Role of neuroimaging on differentiation of Parkinson's disease and its related diseases". Yonago Acta Med (Review). 61 (3): 145–55. doi:10.33160/yam.2018.09.001. PMC   6158357 . PMID   30275744. Parkinsonian syndromes are a group of movement disorders characterized by classical motor symptoms such as tremors, bradykinesia, and rigidity. They are most frequently due to primary neurodegenerative disease, resulting in the loss of dopaminergic nerve terminals along the nigrostriatal pathway, similar to idiopathic PD, MSA, PSP, CBD, and DLB.
  3. 1 2 Barrett KE, Barman SM, Brooks HL, Yuan J (21 January 2019). Ganong's Review of Medical Physiology (26 ed.). McGraw Hill. ISBN   978-1-260-12241-1 . Retrieved 1 April 2024.
  4. ↑ Christine CW, Aminoff MJ (September 2004). "Clinical differentiation of parkinsonian syndromes: prognostic and therapeutic relevance". The American Journal of Medicine. 117 (6): 412–9. doi:10.1016/j.amjmed.2004.03.032. PMID   15380498.
  5. ↑ Kwan LC, Whitehill TL (2011). "Perception of Speech by Individuals with Parkinson's Disease: A Review". Parkinson's Disease. 2011: 389767. doi: 10.4061/2011/389767 . ISSN   2090-8083. PMC   3179876 . PMID   21961077.
  6. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 Jankovic J, Lang AE (2004). "Diagnosis and Assessment". In Bradley, Walter George (ed.). Neurology in Clinical Practice: Principles of diagnosis and management. Vol. 1. Taylor & Francis. pp.  295–96. ISBN   978-99976-25-88-5.
  7. ↑ Algarni M, Fasano A (January 2018). "The overlap between Essential tremor and Parkinson disease". Parkinsonism & Related Disorders. 46 (Suppl 1): S101–S104. doi:10.1016/j.parkreldis.2017.07.006. PMID   28729090.
  8. ↑ Finger EC (April 2016). "Frontotemporal Dementias". Continuum (Review). 22 (2 Dementia): 464–89. doi:10.1212/CON.0000000000000300. PMC   5390934 . PMID   27042904.
  9. ↑ McKeith IG, Boeve BF, Dickson DW, Halliday G, Taylor JP, Weintraub D, et al. (July 2017). "Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium". Neurology (Review). 89 (1): 88–100. doi:10.1212/WNL.0000000000004058. PMC   5496518 . PMID   28592453.
  10. ↑ Maltête D, Guyant-Maréchal L, Mihout B, Hannequin D (March 2006). "Movement disorders and Creutzfeldt-Jakob disease: a review". Parkinsonism & Related Disorders. 12 (2): 65–71. doi:10.1016/j.parkreldis.2005.10.004. PMID   16364674.
  11. ↑ Tse W, Cersosimo MG, Gracies JM, Morgello S, Olanow CW, Koller W (August 2004). "Movement disorders and AIDS: a review". Parkinsonism & Related Disorders. 10 (6): 323–34. doi:10.1016/j.parkreldis.2004.03.001. PMID   15261874.
  12. ↑ Pezzoli G, Cereda E (May 2013). "Exposure to pesticides or solvents and risk of Parkinson disease". Neurology (Meta-analysis). 80 (22): 2035–41. doi:10.1212/WNL.0b013e318294b3c8. PMID   23713084. S2CID   13628268.
  13. 1 2 Guilarte TR, Gonzales KK (August 2015). "Manganese-Induced Parkinsonism Is Not Idiopathic Parkinson's Disease: Environmental and Genetic Evidence". Toxicological Sciences (Review). 146 (2): 204–12. doi:10.1093/toxsci/kfv099. PMC   4607750 . PMID   26220508.
  14. 1 2 Kwakye GF, Paoliello MM, Mukhopadhyay S, Bowman AB, Aschner M (July 2015). "Manganese-Induced Parkinsonism and Parkinson's Disease: Shared and Distinguishable Features". International Journal of Environmental Research and Public Health (Review). 12 (7): 7519–40. doi: 10.3390/ijerph120707519 . PMC   4515672 . PMID   26154659.
  15. ↑ Peres TV, Schettinger MR, Chen P, Carvalho F, Avila DS, Bowman AB, et al. (November 2016). "Manganese-induced neurotoxicity: a review of its behavioral consequences and neuroprotective strategies". BMC Pharmacology & Toxicology (Review). 17 (1): 57. doi: 10.1186/s40360-016-0099-0 . PMC   5097420 . PMID   27814772.
  16. ↑ McKnight S, Hack N (November 2020). "Toxin-Induced Parkinsonism". Neurol Clin (Review). 38 (4): 853–865. doi: 10.1016/j.ncl.2020.08.003 . PMID   33040865. S2CID   222299758.
  17. ↑ Carod-Artal FJ (2003). "[Neurological syndromes linked with the intake of plants and fungi containing a toxic component (I). Neurotoxic syndromes caused by the ingestion of plants, seeds and fruits]". Revista de Neurología (Review) (in Spanish). 36 (9): 860–71. PMID   12717675.
  18. ↑ Kim EA, Kang SK (December 2010). "Occupational neurological disorders in Korea". Journal of Korean Medical Science (Review). 25 (Suppl): S26-35. doi:10.3346/jkms.2010.25.S.S26. PMC   3023358 . PMID   21258587.
  19. ↑ Watanabe Y, Himeda T, Araki T (January 2005). "Mechanisms of MPTP toxicity and their implications for therapy of Parkinson's disease" (PDF). Medical Science Monitor. 11 (1): RA17-23. PMID   15614202.
  20. ↑ Nandipati S, Litvan I (September 2016). "Environmental Exposures and Parkinson's Disease". International Journal of Environmental Research and Public Health (Review). 13 (9): 881. doi: 10.3390/ijerph13090881 . PMC   5036714 . PMID   27598189.
  21. ↑ Weiss J. Chapter 151. Toluene and Xylene. In: Olson KR, ed. Poisoning & Drug Overdose. 6th ed. New York: McGraw-Hill; 2012. http://www.accessmedicine.com/content.aspx?aID=55982958. Accessed April 21, 2013.
  22. ↑ Uitti RJ, Snow BJ, Shinotoh H, Vingerhoets FJ, Hayward M, Hashimoto S, et al. (May 1994). "Parkinsonism induced by solvent abuse". Annals of Neurology. 35 (5): 616–9. doi:10.1002/ana.410350516. PMID   8179306. S2CID   23657208.
  23. ↑ Lai J, Heran MK, Stoessl AJ, Gooderham PA (2017-03-27). "Reversible Parkinsonism and Rapidly Progressive Dementia Due to Dural Arteriovenous Fistula: Case Series and Literature Review". Movement Disorders Clinical Practice. 4 (4): 607–611. doi:10.1002/mdc3.12480. ISSN   2330-1619. PMC   6174482 . PMID   30363443.
  24. ↑ Matsuda S, Waragai M, Shinotoh H, Takahashi N, Takagi K, Hattori T (1999-05-01). "Intracranial dural arteriovenous fistula (DAVF) presenting progressive dementia and parkinsonism". Journal of the Neurological Sciences. 165 (1): 43–47. doi:10.1016/s0022-510x(99)00075-1. ISSN   0022-510X. PMID   10426146. S2CID   31594108.
  25. ↑ Kim HR, Lee JY, Kim YK, Park H, Kim HJ, Son YJ, et al. (September 2015). "Dural Arteriovenous Fistula-Associated Reversible Parkinsonism with Presynaptic Dopaminergic Loss". Journal of Movement Disorders. 8 (3): 141–143. doi:10.14802/jmd.15021. ISSN   2005-940X. PMC   4572665 . PMID   26413242.
  26. ↑ Goldstein S, Friedman JH, Innis R, Seibyl J, Marek K (March 2001). "Hemi-parkinsonism due to a midbrain arteriovenous malformation: dopamine transporter imaging". Movement Disorders. 16 (2): 350–353. doi:10.1002/mds.1047. ISSN   0885-3185. PMID   11295793. S2CID   22701874.
  27. ↑ Armenteros PR, Kapetanovic S, Lopez SG, Vazquez-Lorenzo E, Mendez LA, Muga JJ, et al. (2022-03-29). "Pearls & Oy-sters: Arteriovenous Malformation With Sinus Thrombosis and Thalamic Hemorrhage: Unusual Cause of Parkinsonism and Dementia". Neurology. 98 (13): 550–553. doi: 10.1212/WNL.0000000000200016 . ISSN   0028-3878. PMID   35121672. S2CID   246556634.
  28. ↑ Jubault T, Brambati SM, Degroot C, Kullmann B, Strafella AP, Lafontaine AL, et al. (December 2009). Gendelman HE (ed.). "Regional brain stem atrophy in idiopathic Parkinson's disease detected by anatomical MRI". PLOS ONE. 4 (12): e8247. Bibcode:2009PLoSO...4.8247J. doi: 10.1371/journal.pone.0008247 . PMC   2784293 . PMID   20011063.
  29. ↑ Kuoppamäki M, Rothwell JC, Brown RG, Quinn N, Bhatia KP, Jahanshahi M (April 2005). "Parkinsonism following bilateral lesions of the globus pallidus: performance on a variety of motor tasks shows similarities with Parkinson's disease". Journal of Neurology, Neurosurgery, and Psychiatry. 76 (4): 482–90. doi:10.1136/jnnp.2003.020800. PMC   1739601 . PMID   15774432.
  30. ↑ Halliday GM (2009-12-15). "Thalamic changes in Parkinson's disease". Parkinsonism & Related Disorders. 15: S152–S155. doi:10.1016/S1353-8020(09)70804-1. PMID   20082979.
  31. ↑ Apartis E, Tison F, Arné P, Jedynak CP, Vidailhet M (November 2001). "Fast orthostatic tremor in Parkinson's disease mimicking primary orthostatic tremor". Movement Disorders. 16 (6): 1133–6. doi:10.1002/mds.1218. PMID   11748748. S2CID   36301428.
  32. ↑ Panzer J, Dalmau J (August 2011). "Movement disorders in paraneoplastic and autoimmune disease". Current Opinion in Neurology. 24 (4): 346–53. doi:10.1097/WCO.0b013e328347b307. PMC   3705177 . PMID   21577108.
  33. ↑ Liu Y, Lu Y, Zhang X, Xie S, Wang T, Wu T, et al. (November 2016). "A case of rapid-onset dystonia-parkinsonism accompanied by pyramidal tract impairment". BMC Neurology. 16 (1): 218. doi: 10.1186/s12883-016-0743-8 . PMC   5105251 . PMID   27835968.
  34. ↑ Saito M, Maruyama M, Ikeuchi K, Kondo H, Ishikawa A, Yuasa T, et al. (September 2000). "Autosomal recessive juvenile parkinsonism". Brain & Development. 22 (Suppl 1): S115-7. doi:10.1016/s0387-7604(00)00137-6. PMID   10984671. S2CID   22733500.
  35. ↑ Del Toro-Pérez C, Guevara-Sánchez E, Martínez-Sánchez P (March 2023). "Treatment of Vascular Parkinsonism: A Systematic Review". Brain Sci. 13 (3): 489. doi: 10.3390/brainsci13030489 . PMC   10046744 . PMID   36979299.
  36. ↑ Shin HW, Hong SW, Youn YC (May 2022). "Clinical Aspects of the Differential Diagnosis of Parkinson's Disease and Parkinsonism". J Clin Neurol. 18 (3): 259–270. doi:10.3988/jcn.2022.18.3.259. PMC   9163948 . PMID   35589315.
  37. 1 2 Martí-Massó JF, Poza JJ (1 May 1998). Stoessl AJ, Klein C, Standaert DG (eds.). "Cinnarizine-induced parkinsonism: ten years later". Movement Disorders. 13 (3). Vancouver, British Columbia, Canada: International Parkinson and Movement Disorder Society/Wiley: 453–456. doi:10.1002/mds.870130313. ISSN   1531-8257. PMID   9613736. S2CID   31516105.
  38. ↑ "Information Sheet: Drug-induced Parkinsonism" (PDF). Parkinson's Disease and Society. Archived from the original (PDF) on 2013-06-26. Retrieved 2013-04-15.
  39. ↑ Shuaib UA, Rajput AH, Robinson CA, Rajput A (March 2016). "Neuroleptic-induced Parkinsonism: Clinicopathological study". Movement Disorders. 31 (3): 360–5. doi:10.1002/mds.26467. PMC   5064745 . PMID   26660063.
  40. ↑ Louis ED, Ottman R (November 2013). "Is there a one-way street from essential tremor to Parkinson's disease? Possible biological ramifications". European Journal of Neurology (Review). 20 (11): 1440–4. doi:10.1111/ene.12256. PMC   3801177 . PMID   24033795.
  41. ↑ Fabrizi, Monaco, Dalla Libera (2004). "Parkinsonian syndrome following MDMA (Ecstasy) addiction". Movement Disorders. 19: S73–S74.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  42. ↑ "VA adds three new Agent Orange presumptions". U. S. Department of Veteran Affairs. September 10, 2021. Retrieved March 2, 2022.
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