In 1817, James Parkinson described the shaking palsy now known as Parkinson disease (PD). Descriptions evolved until the term “parkinsonism” now refers to a syndrome characterized by the presence of tremor, rigidity, and bradykinesia in addition to loss of postural reflexes and freezing. The most common cause of parkinsonism is PD. However, in any parkinsonian patient, one must obtain a careful medical and medication history, as drug-induced parkinsonism (DIP) is often reversible, especially if the offending drug is discontinued early.
CASE SCENARIO
A 46-year-old man developed upper limb tremors 2 weeks after initiating perphenazine for mood disorder. Perphenazine was promptly changed to quetiapine, though his tremor persisted. He had a history of hypertension, hypercholesterolemia, and chronic nausea. His medications include verapamil, lovastatin, and metoclopramide.
Motor, sensory, and cerebellar testing were normal. Although mildly stooped, he had normal gait and postural reflexes. Extrapyramidal examination revealed a mild chin tremor, moderate symmetric 3 to 4 Hz resting tremor of the upper and lower limbs, and faster frequency postural tremor of both arms. Finger tapping was moderately irregular bilaterally.
“PEARLS” FOR EVALUATING DIP
Many patients with DIP are often misdiagnosed …
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