Objective: Retrospective study of the outcome of patients with new onset parkinsonism with a history of exposure of a drug known to cause parkinsonism prior to the onset of symptoms who have undergone a TRODAT SPECT scan.

Background: It is difficult to distinguish drug-induced parkinsonism from degenerative parkinsonism on a clinical basis. Dopaminergic SPECT or PET may be helpful in making the differentiation.

Methods: Retrospective study of 17 patients presenting with new onset parkinsonism (at least 2 of 4 cardinal features of PD) who were exposed to drugs known to cause parkinsonism for at least a month and had undergone a dopamine transporter scan (TRODAT) was undertaken. All patients were evaluated with a complete history neurological examination including UPDRS part III and subsequently followed up.

Results: A total of 17 patients :-7 female, 10 males.The average age was 71.61 years. Neurolept Induced worsening was seen in 6/17 patients. Levosulpride induced worsening was seen in 6/17 patients.The average duration of the offending drug consumed was 20.7 months. The average duration of levosulpride induced worsening 4.55 months.7/9 patients with normal uptake improved significantly within 3 months (average 60% reduction on UPDRS III). Long term follow up was available in 5/9 patients, 3 continued to be asymptomatic, 1 had persistence of symptoms and one had initial remission followed by recurrence of parkinsonism.Of the patients having a reduced dopamine uptake 5 patients had an initial partial, less robust recovery, (average 15% reduction on UPDRS III). Long term follow up available for 6/8 patients, 5 had persistence of symptoms requiring dopaminergic medication and 1 had a complete recovery and remained asymptomatic.

Conclusions: Levosulpride is a common offending drug for DIP and can cause parkinsonism after a short exposure.Patients with normal dopaminergic uptake are more likely to have complete short term and long term remission.The patients who have dopaminergic deficits tend to have incomplete recovery and often require dopaminergic drugs indicating the presence of subclinical PD prior to exposure of drugs.The availability of an abnormal dopamine transporter SPECT image will facilitate the decision regarding initiation of dopaminergic therapy.

It has been selected as a platform presentation for 1st Movement Disorder Society Of India Conference (MDSICON2016) Chennai.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/drug-induced-parkinsonism-role-of-functional-imaging-and-follow-up/