Objective: To understand the pattern of movement disorders caused by migraine prophylactic medicine such as flunarizine.

Background: Migraine prophylactic treatments are usually taken for short or long term duration. Flunarazine is a calcium channel antagonist and also a mild dopamine antagonist. It is likely that its long term treatments might be associated with various movement disorders.

Method: During our outpatient clinic at Department of Neurology, Tribhuvan University Teaching Hospital in last 1 year, came across 2 interesting patients who were being treated for migraine with Flunarizine and later further treated as Parkinson´s Disease with levodopa and carbidopa in subsequent follow-up.

Results: Case 1: 72-year-old male, had been taking flunarizine 10mg for more than 2 years whose headache was well controlled after medicine presented to the local physician for his new symptoms of resting tremor in right hand. He was then prescribed with levodopa-carbidopa 125mg. However, his symptoms were static. During his visit to our clinic, patient was bradykinetic, prominent resting tremor in right side and whole-body tremulousness. After the stopping of flunarizine and levodopa-carbidopa and addition of trihexyphenidyl 1mg twice a day, patient significantly improved in 1 month. In subsequent follow-up after 2 months elicited complete resolution of features of parkinsonism.

Case 2: 68-year-old female, was prescribed with propranolol 20mg and flunarizine 10mg from our clinic for her frequent migraine episodes and was asked for follow-up in 3 months. However, patient presented in a year with improvement in headache episodes. On the other hand, she had increased generalized slowness, generalized body tremor and reduced facial expression as noticed by her family members. Flunarizine was changed to dosulepin 25mg and followed in 2 months with minimal bradykinesia and mask face and resolved tremor.

( Videos will be made available during poster presentation)

Conclusion: We should be cautious prescribing Flunarizine in elderly people, low-dose treatment, needed proper counselling beforehand regarding the likelyhood of motor adverse effects and regular monitoring of symptoms is needed. Early diagnosis cause reversal of symptoms and reduce the disease and economic burden of patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/drug-induced-parkinsonism-mimicking-parkinsons-disease-in-patients-treated-with-flunarizine-for-migraine/