Objective: To establish clinical and MRI morphometric differences between Parkinson’s disease (PD) and Drug-induced parkinsonism (DP).

Background: DP – is the most known side effect of dopamine-blocking drugs, occurs in 15-60% of patients taking antipsychotic medications. It is believed that by motor manifestations, DP is indistinguishable from PD. There are no clear data in the literature about the symmetry of the distribution of symptoms in the DP.

Methods: The study involved 28 patients with DP (average age 47,7 ± 4,3 years). The average duration of the underlying process – 16,01 ± 3,28 years. All patients received antipsychotic drugs of different pharmacological groups. The control group consisted of 43 patients with PD. MRI-morphometric parameters were evaluated for axial sections in the magnetic field of 1.5 Tesla. In T1-weighted images were measured anteroposterior and lateral dimensions of the pons, midbrain, and IV ventricle. In T2-weighted images were measured longitudinal and transverse dimensions of subcortical nucleus.

Results: For DP determined characteristics of symmetrical distribution of symptoms (64.7%), bradykinesia (100%), postural disorders (88.2%) and combinations with other movement disorders (31.2%). Compared to PD, in DP determined "Parkinsonian" resting tremor (88.4% and 47.1%, respectively, p<0.001), although other types of tremors such as kinetic (23.5%) and postural signs (35, 3%), were uncommon. In patients with DP, there were not observed flexor poses and postural signs such as spontaneous propulsion and syndrome " marking time". MRI, in patients with DP, showed increased size of the midbrain, IV ventricle, the upper peduncle of cerebellum, the transversal dimensions of the globus pallidus and caudate nucleus, rudecued size the anteroposterior size of the caudate nucleus and frontoparietal atrophy. This elongated shell decreased in the transversal dimensions (the transverse dimension in PD -10,8 ± 0,5 mm, DP – 7,9 ± 0,6 mm, p <0.01), and the caudate nucleus, in contrast, expanded and decreased in length (transverse dimension in PD – 8,8 ± 0,3 mm, LP – 9,5 ± 0,3 mm, p <0.01).

Conclusions: There were detected mainly symmetric symptoms of Parkinson’s disease with a prevalence of bradykinesia in DP. Rest tremor was determined less than in PD, but other types of tremor (kinetic, postural) turned out to be typical for the DP. Severe postural disorders also were observed in patients with DP.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-and-mri-characteristics-of-drug-induced-parkinsonism-in-uzbekistan/