Journal of Young Pharmacists, 2024; 16(1):137-138.

https://www.jyoungpharm.org Case Report

Chronic Neuroleptic Therapy and Progressive Parkinsonism:

A Case Report
Anusha Rao, Shristi Reddy, Sanatkumar Bharamu Nyamagoud*, Agadi Hiremath Viswanatha Swamy
Department of Pharmacy Practice, KLE College of Pharmacy (A Constituent Unit of KLE Academy of Higher Education and Research, Belagavi),
Vidyanagar, Hubballi, Karnataka, INDIA.

Correspondence:
ABSTRACT Dr. Sanatkumar Bharamu Nyamagoud
This case report presents the challenging clinical scenario of a middle-aged male patient with a Assistant Professor, Department of
decade-long history of psychiatric illness on chronic neuroleptic therapy. The patient's symptoms Pharmacy Practice, KLE College of
initially manifested as tremors a year ago, subsequently progressing to resting tremors, head Pharmacy (A Constituent Unit of KLE
titubation, and impaired mobility. Typically, Drug-Induced Parkinsonism (DIP) occurs within three Academy of Higher Education and
months of initiating neuroleptic treatment, this case presents a unique and prolonged timeline, Research, Belagavi), Vidyanagar, Hubballi,
raising questions about the underlying aetiology complexed with patients' imaging studies Karnataka, INDIA.
revealing age related atrophy. The bilateral and symmetrical motor signs observed align with DIP Email: dr.sanathnyamagoud@gmail.com
characteristics, although studies report asymmetrical signs, introducing diagnostic complexities.
This case emphasizes the need for further research on understanding the effect of chronic Received: 17-10-2023;
neuroleptic use, age-related structural alterations, and the potential unmasking of underlying
Revised: 04-12-2023;
Parkinsonism for improving diagnostic accuracy and tailoring effective management strategies
Accepted: 10-01-2024.
for patients with similar challenging presentations.

Keywords: Prolonged neuroleptic exposure, Parkinsonian symptoms, Drug-Induced

Parkinsonism, Anti-psychotic therapy, Extrapyramidal symptoms, Age-related cerebral atrophy.

INTRODUCTION
Drug-Induced Parkinsonism (DIP) is an extrapyramidal adverse highlighting the challenges in the diagnosis and treatment of
effect resulting from the use of various drugs, with anti-psychotic drug-induced Parkinsonism.
medications being the primary and most common contributors.1
Diagnosing Drug-Induced Parkinsonism (DIP) distinctively CASE PRESENTATION
from Idiopathic Parkinson's Disease (IPD) poses challenges, A 56-year-old male patient, previously diagnosed with psychiatric
hindering precise prevalence data collection. Despite this illness for the past decade, was being managed with medications
difficulty, DIP accounts for a prevalence ranging from 0.09% including Tab. Risperidone 2 mg, Tab. Chlorpromazine 100
to 2.7%, positioning it as the second most prevalent cause of mg, Tab. Trihexyphenidyl 2 mg, and Sodium Valproate 500 mg
Parkinsonism.2 Extrapyramidal Symptoms (EPS) primarily BD. He had a history of a Generalized Tonic-Clonic Seizure
stem from the blockade of D2 receptors in the mesolimbic and (GTCS) a year ago, on physical examination, the patient had
mesocortical pathways within the basal ganglia.2 Notably, these mild tremors which was managed with sodium valproate and
symptoms can endure in approximately 25% of patients even after trihexyphenidyl, and was advised to continue the antipsychotics
discontinuing the causative drugs. Risk factors for Drug-Induced prescribed previously. Presently the patient came with complaints
Parkinsonism (DIP) include advanced age, female gender, organic of abnormal movements of both upper limb and lower limb since
brain damage, atrophy, and dementia, highlighting the importance one month, generalized weakness since 15 days, and unable to
of recognizing these factors in clinical assessments.3 Here we walk since fifteen days. On examination, he exhibited resting
present a case of a 56-year-old patient presenting Parkinson-like tremors, head titubation, and cogwheel rigidity bilaterally. CT
symptoms while on antipsychotic and antiepileptic medications, and MRI showed age-related cerebral atrophy, chronic bilateral
corona radiata infarcts, and hypertensive leukoencephalopathy.
DOI: 10.5530/jyp.2024.16.19 He was also displaying behavioural issues such as irritability,
verbal and physical aggression, and suspiciousness towards his
Copyright Information :
Copyright Author (s) 2024 Distributed under wife. There was no history of substance abuse, psychiatry illness
Creative Commons CC-BY 4.0 in family, no withdrawal symptoms, and at initial presentation
Publishing Partner : EManuscript Tech. [www.emanuscript.in]
the patient denied any illness.

Journal of Young Pharmacists, Vol 16, Issue 1, Jan-Mar, 2024 137

 Rao, et al.: Chronic Neuroleptic Therapy and Progressive Parkinsonism

Upon referral to the psychiatry department, it was determined Further insights into the complex interplay between chronic
that the patient was suffering from drug-induced Parkinsonism neuroleptic use, age-related brain changes, and the potential
consequently; Tab. Chlorpromazine and Tab Sodium Valproate unmasking of underlying PD are essential. Longitudinal studies
were discontinued. He was prescribed Tab. Risperidone 2 mg examining patients with prolonged neuroleptic exposure and
(0-0-1), Tab. Trihexyphenidyl 2 mg (1-1-0), Tab. Levodopa 110 detailed neuroimaging assessments could shed light on the
mg (1/2-1/2-1/2), and Tab. Clonazepam 0.25 mg (0-0-1). Despite mechanisms leading to progressive Parkinsonism. Additionally,
some improvement in symptoms, extrapyramidal symptoms exploring the variations in treatment responses, especially
persisted. concerning levodopa, in patients with different psychiatric
Upon discharge on the 11th day, the patient was prescribed Tab. profiles could provide valuable insights for tailored therapeutic
Levodopa 110 mg (1/2-1/2-1/2) for 15 days, Tab. Clonazepam 0.25 interventions.
mg (0-0-1), Tab. Aspirin 75 mg (0-1-0), Tab. Atorvastatin 20 mg
(0-0-1), Tab. Risperidone 2 mg (0-0-1), and Tab. Trihexyphenidyl CONCLUSION
2 mg (1-1-0). He was advised to follow up in the outpatient In conclusion, this case emphasizes the intricate nature of DIP
department for further evaluation and management. in the context of chronic neuroleptic therapy and age-related
brain changes. Understanding the underlying mechanisms and
DISCUSSION
clarifying the diagnostic criteria for distinguishing DIP from
This case presents a unique challenge in understanding the emerging PD are crucial. Further research addressing these
etiology of drug-induced Parkinsonism (DIP) in a patient with a complexities will enhance our diagnostic accuracy and pave
decade-long history of neuroleptic use. Typically, DIP manifests the way for more effective management strategies tailored to
within three months of drug initiation;4 however, this patient's individual patient profiles.
symptoms, which started as tremors a year ago, progressed
significantly, leading to resting tremors, head titubation, and CONFLICT OF INTEREST
impaired mobility. The progressive nature of the symptoms after
The authors declare that there is no conflict of interest.
a long duration of neuroleptic therapy raises questions about the
underlying mechanisms. REFERENCES
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Cite this article: Rao A, Reddy S, Nyamagoud SB, Swamy AHV. Chronic Neuroleptic Therapy and Progressive Parkinsonism: A Case Report. J Young Pharm.
2024;16(1):137-8.

138 Journal of Young Pharmacists, Vol 16, Issue 1, Jan-Mar, 2024