Objective: To describe the effect of chronic intake of disulfiram

Background: Background- Drug induced parkinsonism is one of the commonest causes of non-degenerative parkinsonism. Typical antipsychotic agents and anti-emetic agents are the commonest causes. We describe parkinsonism in a patient with chronic disulfiram overdose.

Method: Case report

Results: A 43 year old gentleman presented history of cognitive impairment and gait disturbances of 3 months duration. Cognitive impairment was in the form of short-term memory impairment. He was noted to have occasionally non purposive handling of his clothes and surrounding objects. He was prescribed disulfiram 250 mg daily as a treatment of alcohol deaddiction but had been taking around 8 tablets of 250 mg disulfiram daily since past 6 months and had recently stopped disulfiram.  He denied any other drug or substance abuse.

On examination, he would tend to stutter while speaking. Occasional perseveration of speech was noted. Mental status examination revealed impaired attention, working memory, verbal and visual learning and executive function. Symmetrical bradykinesia of limbs (lower > upper) was noted with mild rigidity of lower limb. He struggled to rise from the chair. Gait examination revealed narrow stance, short and shuffling gait, decreased foot clearance off the ground and occasional tendency to have retropulsion while walking.

 MRI brain showed T2/ FLAIR bilateral globus pallidus and substantia nigra hyperintensities with no evidence of diffusion restriction or blooming. He was initiated on levodopa without improvement. However, three months after discontinuation of disulfiram, he was easily able to rise from the chair and there was significant improvement in gait.

Conclusion: Neurological effects have been reported following chronic disulfiram consumption when taken at higher doses and even at therapeutic doses of disulfiram.  Daily dose of 500 mg of disulfiram for three years was associated with parkinsonism that improved partially on discontinuing disulfiram.  These symptoms may be the consequence of the toxic effects of the metabolites of disulfiram on the basal ganglia. This report highlights chronic disulfiram overdose as a cause of parkinsonism and basal ganglia hyperintensities in imaging

References: 1.Shin HW, Chung SJ. Drug-induced parkinsonism. Journal of clinical neurology. 2012 Mar 1;8(1):15-21.
2. Boukriche Y, Weisser I, Aubert P, Masson C. MRI findings in case of late onset disulfiram-induced neurotoxicity. Journal of neurology. 2000;247(9):714
3. Borrett D, Ashby P, Bilbao J, Carlen P. Reversible, late‐onset disulfiram‐induced neuropathy and encephalopathy. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society. 1985;17(4):396-9.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsonism-following-chronic-disulfiram-overdose/