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Hearn E. The challenges in managing co-occurring Parkinson's and schizophrenia spectrum disorders. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:996-1002. [PMID: 37938992 DOI: 10.12968/bjon.2023.32.20.996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
This article explores the relationship between Parkinson's and schizophrenia spectrum disorders, discussing not only the possibility that they can be comorbid conditions but that the presence of one could increase the chances of developing the other. They are rarely documented together, other than in relation to medication-induced side effects, and this could be due to diagnostic overshadowing, or the widely held belief that these conditions are not able to co-exist. It also briefly discusses treatment options available and gaps identified for future research.
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Ren Z, Xu Y, Sun J, Han Y, An L, Liu J. Chronic diseases and multimorbidity patterns, their recent onset, and risk of new-onset Parkinson's disease and related functional degeneration in older adults: a prospective cohort study. EClinicalMedicine 2023; 65:102265. [PMID: 37855021 PMCID: PMC10579290 DOI: 10.1016/j.eclinm.2023.102265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023] Open
Abstract
Background Certain chronic diseases contribute to increased risks of Parkinson's disease (PD), but the association between time-varying multimorbidity patterns and new-onset PD remains underexplored. Methods Data were from the Survey of Health, Ageing and Retirement in Europe (SHARE) waves 5-8 conducted between January 2013 and March 2020. Eleven chronic diseases were included, with ≥2 denoting multimorbidity. Three multimorbidity patterns were further defined: somatic multimorbidity (SMM), neuropsychiatric multimorbidity (NPM), and cardiometabolic multimorbidity (CMM). PD-related function degeneration included functional limitations, mobility limitations, depressive symptoms, and cognitive decline. Time-dependent analyses, competing-risk analyses, and mixed-effect models were utilised. Findings In this prospective cohort study, 557 developed new-onset PD during follow-ups among 64,273 participants included at baseline, as defined by participants' self-reported physician diagnoses. Participants with (vs. without) multimorbidity, SMM, NPM, and CMM were at 1.40-2.70 times higher PD risk after considering the competing role of all-cause death, which remained significant in all sensitivity analyses and were more pronounced in lower-income participants (P for interaction <0.05). Similarly, they tended to develop functional degeneration faster than those without these multimorbidity patterns (P < 0.05). Participants with recent-onset (newly diagnosed in 2015) multimorbidity patterns were at 1.45-3.72 times higher risk of PD than those never diagnosed. Interestingly, they were at comparable or even higher (though P values for >0.05) PD risk compared to participants with multimorbidity patterns diagnosed in 2013 or before. Furthermore, recent-onset (vs. prior diagnosed) NPM exhibited faster functional deterioration and cognitive decline (P for difference <0.05). Interpretation Our findings suggest that promoting early prevention of multimorbidity, especially recent-onset multimorbidity and NPM, could prevent some subsequent cases of PD and related functional degeneration among older adults. However, further studies are needed to confirm this association. Funding The National Key Research and Development Program, Ministry of Science and Technology, China; Zhongnanshan Medical Foundation of Guangdong Province; Major Project of the National Social Science Fund of China; Fundamental Research Funds for the Central Universities.
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Affiliation(s)
- Ziyang Ren
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yunhan Xu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Jinfang Sun
- Office of Epidemiology, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yanqing Han
- Department of Neurology, Cardiovascular Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Lin An
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Jufen Liu
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Kaur U, Chakrabarti SS, Reddy J, Singh A, Gambhir IS. Patterns and determinants of drug-related neurological problems in older outpatients: An exploratory analysis of a six-year long observational study in North India. Int Psychogeriatr 2023; 35:673-676. [PMID: 37807932 DOI: 10.1017/s1041610223000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Affiliation(s)
- Upinder Kaur
- Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sankha Shubhra Chakrabarti
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Jaideep Reddy
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Amit Singh
- Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Indrajeet Singh Gambhir
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Liotta M, Bell H, Vu AT, Stillman M. Drug-Induced Parkinsonism: Too Many Cooks in the Kitchen. Cureus 2023; 15:e44896. [PMID: 37814773 PMCID: PMC10560449 DOI: 10.7759/cureus.44896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
Drug-induced parkinsonism (DIP) is a condition characterized by the development of parkinsonian symptoms as a result of medication use. It is often misdiagnosed and can be challenging to differentiate from Parkinson's disease (PD). In this case presentation, we describe the clinical course of a 64-year-old male who presented with parkinsonian symptoms while using atypical antipsychotics, which was originally misdiagnosed as PD. The case highlights the importance of recognizing the potential iatrogenic effects of medications with antidopaminergic properties, such as antipsychotics and antiepileptic drugs, which are common culprits in causing DIP. We discuss DIP management, long-term impacts, and differentiating DIP from PD through clinical findings and imaging, emphasizing the utility of the (123)I-ioflupane single-photon emission computerized tomography (SPECT) scan in aiding diagnosis. This case serves as a reminder to healthcare providers to remain vigilant in monitoring patients for adverse effects, polypharmacy, and harmful medication interactions.
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Affiliation(s)
- Mark Liotta
- Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Harrison Bell
- Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Anh-Thu Vu
- Neurology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Michael Stillman
- Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, USA
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Jeon SM, Lee YJ, Kwon JW. Prevalence and causative drugs of drug-induced Parkinsonism in pediatric patients. Eur Child Adolesc Psychiatry 2023; 32:1805-1814. [PMID: 37039890 DOI: 10.1007/s00787-023-02207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/05/2023] [Indexed: 04/12/2023]
Abstract
Although several studies provided evidence on the epidemiology of drug-induced Parkinsonism (DIP) and its causative drugs, it is still limited in pediatrics. This study aimed to investigate the prevalence and risk of DIP in pediatrics. We used the Health Insurance Review and Assessment Service-Pediatric Patients Sample in Korea between 2010 and 2017 to estimate the annual prevalence of DIP and causative drug use using a cross-sectional design. The risk of DIP associated with causative drugs was evaluated using a case-crossover design. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated using a conditional logistic regression. A total of 2925 pediatric patients had diagnosed with DIP from 2010 to 2017. Most patients were aged between 12 and19 years old, and 99.8% had any diagnosis of mental health disorder (MHD). During the study period, the prevalence of DIP increased by 10.0-fold from 2010 to 2017. All causative drugs showed a corresponding increase in their use, with atypical antipsychotics being the most prominent (increase ratio, 2.07). For both in the prevalence of DIP and atypical antipsychotic use, the increment was much bigger in patients with non-psychotic MHD than that in patients with psychotic MHD. In the case-crossover study, antipsychotics showed the largest aOR with DIP. Risperidone among antipsychotics showed the highest risk for DIP (aOR = 7.09, 95% CI = 3.83-13.09), followed by aripiprazole (aOR = 5.03, 95% CI = 2.88-8.80). This study suggests that the increase in DIP prevalence in pediatric patients might be because of the increased use of atypical antipsychotics.
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Affiliation(s)
- Soo Min Jeon
- College of Pharmacy, Jeju National University, Jeju, South Korea
| | - Yu Jin Lee
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, 80 Daehak-Ro, Daegu, 41566, South Korea
| | - Jin-Won Kwon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, 80 Daehak-Ro, Daegu, 41566, South Korea.
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Rissardo JP, Vora N, Mathew B, Kashyap V, Muhammad S, Fornari Caprara AL. Overview of Movement Disorders Secondary to Drugs. Clin Pract 2023; 13:959-976. [PMID: 37623268 PMCID: PMC10453030 DOI: 10.3390/clinpract13040087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
Drug-induced movement disorders affect a significant percentage of individuals, and they are commonly overlooked and underdiagnosed in clinical practice. Many comorbidities can affect these individuals, making the diagnosis even more challenging. Several variables, including genetics, environmental factors, and aging, can play a role in the pathophysiology of these conditions. The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD) are the most commonly used classification systems in categorizing drug-induced movement disorders. This literature review aims to describe the abnormal movements associated with some medications and illicit drugs. Myoclonus is probably the most poorly described movement disorder, in which most of the reports do not describe electrodiagnostic studies. Therefore, the information available is insufficient for the diagnosis of the neuroanatomical source of myoclonus. Drug-induced parkinsonism is rarely adequately evaluated but should be assessed with radiotracers when these techniques are available. Tardive dyskinesias and dyskinesias encompass various abnormal movements, including chorea, athetosis, and ballism. Some authors include a temporal relationship to define tardive syndromes for other movement disorders, such as dystonia, tremor, and ataxia. Antiseizure medications and antipsychotics are among the most thoroughly described drug classes associated with movement disorders.
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Affiliation(s)
| | - Nilofar Vora
- Medicine Department, Terna Speciality Hospital and Research Centre, Navi Mumbai 400706, India;
| | - Bejoi Mathew
- Medicine Department, Sri Devaraj Urs Medical College, Kolar Karnataka 563101, India;
| | - Vikas Kashyap
- Medicine Department, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India;
| | - Sara Muhammad
- Neurology Department, Mayo Clinic, Rochester, MN 55906, USA;
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Kim S, Suh HS. Treatment Changes and Prognoses in Patients with Incident Drug-Induced Parkinsonism Using a Korean Nationwide Healthcare Claims Database. J Clin Med 2023; 12:jcm12082860. [PMID: 37109197 PMCID: PMC10145513 DOI: 10.3390/jcm12082860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
This retrospective cohort study assessed treatment changes and prognoses after incident drug-induced parkinsonism (DIP). We used the National Health Insurance Service's National Sample Cohort database in South Korea. We selected patients diagnosed with incident DIP and given prescriptions to take offending drugs (antipsychotics, gastrointestinal (GI) motility drugs, or flunarizine) for a period of time that overlapped with the time of DIP diagnosis during 2004-2013. The proportion of patients experiencing each type of treatment change and prognosis was assessed for 2 years after DIP diagnosis. We identified 272 patients with incident DIP (51.9% of patients were aged ≥ 60 years and 62.5% of them were women). Switching (38.4%) and reinitiation (28.8%) were the most common modifications in GI motility drug users, whereas dose adjustment (39.8%) and switching (23.0%) were common in antipsychotic users. The proportion of persistent users was higher among antipsychotic users (7.1%) than that among GI motility drug users (2.1%). Regarding prognosis, 26.9% of patients experienced DIP recurrence or persistence, the rate being the highest in persistent users and the lowest in patients who discontinued the drug. Among patients with incident DIP diagnoses, the patterns of treatment change and prognosis differed across the types of offending drugs. Over 25% of patients experienced DIP recurrence or persistence, highlighting the need for an effective strategy to prevent DIP.
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Affiliation(s)
- Siin Kim
- College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea
- Institute of Regulatory Innovation through Science, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hae Sun Suh
- College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea
- Institute of Regulatory Innovation through Science, Kyung Hee University, Seoul 02447, Republic of Korea
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
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Qiao J, Wang C, Chen Y, Yu S, Liu Y, Yu S, Jiang L, Jin C, Wang X, Zhang P, Zhao D, Wang J, Liu M. Herbal/Natural Compounds Resist Hallmarks of Brain Aging: From Molecular Mechanisms to Therapeutic Strategies. Antioxidants (Basel) 2023; 12:antiox12040920. [PMID: 37107295 PMCID: PMC10136184 DOI: 10.3390/antiox12040920] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Aging is a complex process of impaired physiological integrity and function, and is associated with increased risk of cardiovascular disease, diabetes, neurodegeneration, and cancer. The cellular environment of the aging brain exhibits perturbed bioenergetics, impaired adaptive neuroplasticity and flexibility, abnormal neuronal network activity, dysregulated neuronal Ca2+ homeostasis, accumulation of oxidatively modified molecules and organelles, and clear signs of inflammation. These changes make the aging brain susceptible to age-related diseases, such as Alzheimer's and Parkinson's diseases. In recent years, unprecedented advances have been made in the study of aging, especially the effects of herbal/natural compounds on evolutionarily conserved genetic pathways and biological processes. Here, we provide a comprehensive review of the aging process and age-related diseases, and we discuss the molecular mechanisms underlying the therapeutic properties of herbal/natural compounds against the hallmarks of brain aging.
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Affiliation(s)
- Juhui Qiao
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Chenxi Wang
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Yu Chen
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Shuang Yu
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Ying Liu
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Shiting Yu
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Leilei Jiang
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Chenrong Jin
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Xinran Wang
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Peiguang Zhang
- Changchun Institute of Optics, Fine Mechanics and Physics, Chinese Academy of Sciences, Changchun 130033, China
| | - Daqing Zhao
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, China
| | - Jiawen Wang
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, China
- Division of Cardiovascular Medicine, Department of Medicine, Solna, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Meichen Liu
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, China
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Calzetti S, Negrotti A. Permanent non-progressive cinnarizine and flunarizine-induced parkinsonism: An under-recognized tardive syndrome in the elderly? J Neurol Sci 2023; 444:120526. [PMID: 36584558 DOI: 10.1016/j.jns.2022.120526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 09/16/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Secondary parkinsonism induced by exposure to dopamine (DA) receptor antagonists as first and second generation antipsychotics, DA storage depleters, calcium channel blockers, benzamides substituted and other classes of drugs is traditionally believed to be completely reversible in most of patients following withdrawal of the offending drug even though after a variable time delay. The lack of recovery or initial full recovery with subsequent development of progressive parkinsonism has been regarded to result from an underlying subclinical degenerative process like PD unmasked by the inducing drug. These well-recognized clinical outcomes of drug-induced parkinsonism (DIP) have disregarded the existence of another outcome, characterized by permanent non-progressive parkinsonism. This syndrome may fullfil the criteria of tardive parkinsonism, a controversial entity currently referred to as a persistent condition without indication of its long-term course and clinical features. On reviewing the published literature on DIP, we have identified two prospective long-term follow-up of elderly patients in which parkinsonism induced by the calcium channel antagonists cinnarizine and flunarizine became permanent and non-progressive following drug discontinuation in a non-negligible proportion of patients, consistent with the clinical concept of a true tardive syndrome, according to currently accepted criteria. The authors hypothesize that the development of tardive parkinsonism might be due to a neurotoxic effect of the pharmacodynamic proprieties of the calcium channel blockers and their metabolites, exerted on post-synaptic striatal neurons and/or a neurotoxic damage on presynaptic DA neurons in patients without an underlying subclinical degenerative parkinsonism, so accounting for the stable and non-progressive course over time.
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Affiliation(s)
- Stefano Calzetti
- Neurology Unit, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci, 14, 43126 Parma, Italy.
| | - Anna Negrotti
- Neurology Unit, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci, 14, 43126 Parma, Italy.
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Parkinson's Disease-Related Brain Metabolic Pattern Is Expressed in Schizophrenia Patients during Neuroleptic Drug-Induced Parkinsonism. Diagnostics (Basel) 2022; 13:diagnostics13010074. [PMID: 36611366 PMCID: PMC9818349 DOI: 10.3390/diagnostics13010074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
Drug-induced parkinsonism (DIP) is a frequent parkinsonian syndrome that appears as a result of pharmacotherapy for the management of psychosis. It could substantially hamper treatment and therefore its diagnosis has a direct influence on treatment effectiveness. Although of such high importance, there is a lack of systematic research for developing neuroimaging-based criteria for DIP diagnostics for such patients. Therefore, the current study was aimed at applying a metabolic brain imaging approach using the 18F-FDG positron emission tomography and spatial covariance analysis to reveal possible candidates for DIP markers. As a result, we demonstrated, to our knowledge, the first attempt at the application of the Parkinson's Disease-Related Pattern (PDRP) as a metabolic signature of parkinsonism for the assessment of PDRP expression for schizophrenia patients with DIP. As a result, we observed significant differences in PDRP expression between the control group and the groups with PD and DIP patients. Similar differences in PDRP expression were also found when the non-DIP schizophrenia patients were compared with the PD group. Therefore, our findings made it possible to conclude that PDRP is a promising tool for the development of clinically relevant criteria for the estimation of the risk of developing DIP.
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SLC6A3, HTR2C and HTR6 Gene Polymorphisms and the Risk of Haloperidol-Induced Parkinsonism. Biomedicines 2022; 10:biomedicines10123237. [PMID: 36551993 PMCID: PMC9776373 DOI: 10.3390/biomedicines10123237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
Antipsychotic-induced parkinsonism (AIP) is the most common type of extrapyramidal side effect (EPS), caused by the blockage of dopamine receptors. Since dopamine availability might influence the AIP risk, the dopamine transporter (DAT) and serotonin receptors (5-HTRs), which modulate the dopamine release, may be also involved in the AIP development. As some of the individual differences in the susceptibility to AIP might be due to the genetic background, this study aimed to examine the associations of SLC6A3, HTR2C and HTR6 gene polymorphisms with AIP in haloperidol-treated schizophrenia patients. The Extrapyramidal Symptom Rating Scale (ESRS) was used to evaluate AIP as a separate entity. Genotyping was performed using a PCR, following the extraction of blood DNA. The results revealed significant associations between HTR6 rs1805054 polymorphism and haloperidol-induced tremor and rigidity. Additionally, the findings indicated a combined effect of HTR6 T and SLC6A3 9R alleles on AIP, with their combination associated with significantly lower scores of ESRS subscale II for parkinsonism, ESRS-based tremor or hyperkinesia and ESRS subscales VI and VIII. These genetic predictors of AIP could be helpful in better understanding its pathophysiology, recognizing the individuals at risk of developing AIP and offering personalized therapeutic strategies for the patients suffering from this EPS.
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Rissardo JP, Caprara ALF. Phenytoin-associated movement disorder: A literature review. Tzu Chi Med J 2022; 34:409-417. [PMID: 36578637 PMCID: PMC9791846 DOI: 10.4103/tcmj.tcmj_74_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/07/2022] [Accepted: 06/23/2022] [Indexed: 11/07/2022] Open
Abstract
Phenytoin (PHT) was first synthesized as a barbiturate derivative and was approved in 1953 by the Food and Drug Administration. This work aimed to review the pathophysiology, epidemiology, clinical presentation, and treatment of PHT-associated movement disorders (MDs). Studies were searched in relevant databases (ScienceDirect, Google Scholar, Excerpta Medica, Latin American and Caribbean Health Sciences Literature, Medline, and Scientific Electronic Library Online) and were selected by two reviewers irrespective of language between 1963 and 2021. Papers of PHT-induced ataxia alone or tremor were excluded. In total, 127 reports with 219 individuals who developed MDs associated with PHT were encountered. MDs found: 126 dyskinesias, 49 myoclonus, 19 dystonia, 14 parkinsonism, 6 tics, 3 stuttering, and 2 restless legs syndrome. The mean age was 35 years (standard deviation [SD]: 23.5) and the predominant sex was male (53.4%). The mean PHT dose when the MD took place was 370.4 mg (SD: 117.5). A serum PHT concentration was reported in 103 cases, ranging from 4 to 110 μg/mL (median: 27.7 μg/mL). No significant relationship was found between PHT dose and age or PHT level. The mean onset time of PHT-associated MD was 23.4 months (SD: 4.4). The mean recovery time after MD management was 3.7 weeks (SD: 1.1). Regarding management, the most common form was PHT withdrawal in 90.4%. 86.3% of the individuals recovered fully. PHT-induced MD was extensively reported in the literature. Only general terms were used in the majority of the reports. The mechanisms underlying the adverse events caused by PHT probably depend on the presence of predisposing factors.
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Affiliation(s)
- Jamir Pitton Rissardo
- Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil,Address for correspondence: Dr. Jamir Pitton Rissardo, Department of Medicine, Federal University of Santa Maria, Av. Roraima, 1000 - Camobi, Santa Maria - RS, Brazil. E-mail:
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Cronin SJF, Rao S, Tejada MA, Turnes BL, Licht-Mayer S, Omura T, Brenneis C, Jacobs E, Barrett L, Latremoliere A, Andrews N, Channon KM, Latini A, Arvanites AC, Davidow LS, Costigan M, Rubin LL, Penninger JM, Woolf CJ. Phenotypic drug screen uncovers the metabolic GCH1/BH4 pathway as key regulator of EGFR/KRAS-mediated neuropathic pain and lung cancer. Sci Transl Med 2022; 14:eabj1531. [PMID: 36044597 PMCID: PMC9985140 DOI: 10.1126/scitranslmed.abj1531] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Increased tetrahydrobiopterin (BH4) generated in injured sensory neurons contributes to increased pain sensitivity and its persistence. GTP cyclohydrolase 1 (GCH1) is the rate-limiting enzyme in the de novo BH4 synthetic pathway, and human single-nucleotide polymorphism studies, together with mouse genetic modeling, have demonstrated that decreased GCH1 leads to both reduced BH4 and pain. However, little is known about the regulation of Gch1 expression upon nerve injury and whether this could be modulated as an analgesic therapeutic intervention. We performed a phenotypic screen using about 1000 bioactive compounds, many of which are target-annotated FDA-approved drugs, for their effect on regulating Gch1 expression in rodent injured dorsal root ganglion neurons. From this approach, we uncovered relevant pathways that regulate Gch1 expression in sensory neurons. We report that EGFR/KRAS signaling triggers increased Gch1 expression and contributes to neuropathic pain; conversely, inhibiting EGFR suppressed GCH1 and BH4 and exerted analgesic effects, suggesting a molecular link between EGFR/KRAS and pain perception. We also show that GCH1/BH4 acts downstream of KRAS to drive lung cancer, identifying a potentially druggable pathway. Our screen shows that pharmacologic modulation of GCH1 expression and BH4 could be used to develop pharmacological treatments to alleviate pain and identified a critical role for EGFR-regulated GCH1/BH4 expression in neuropathic pain and cancer in rodents.
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Affiliation(s)
- Shane J. F. Cronin
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, Vienna A-1030, Austria
| | - Shuan Rao
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, Vienna A-1030, Austria
| | - Miguel A. Tejada
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, Vienna A-1030, Austria
| | - Bruna Lenfers Turnes
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Simon Licht-Mayer
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, Vienna A-1030, Austria
| | - Takao Omura
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Christian Brenneis
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Emily Jacobs
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Lee Barrett
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Alban Latremoliere
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA
- Departments of Neurosurgery and Neuroscience, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Nick Andrews
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Keith M. Channon
- Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Alexandra Latini
- LABOX, Departamento de Bioquímica, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Anthony C. Arvanites
- Department of Stem Cell and Regenerative Biology, Harvard University, 7 Divinity Ave, Cambridge, MA 02138, USA
- Harvard Stem Cell Institute, Harvard University, Cambridge, MA 02138, USA
| | - Lance S. Davidow
- Department of Stem Cell and Regenerative Biology, Harvard University, 7 Divinity Ave, Cambridge, MA 02138, USA
- Harvard Stem Cell Institute, Harvard University, Cambridge, MA 02138, USA
| | - Michael Costigan
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Lee L. Rubin
- Department of Stem Cell and Regenerative Biology, Harvard University, 7 Divinity Ave, Cambridge, MA 02138, USA
- Harvard Stem Cell Institute, Harvard University, Cambridge, MA 02138, USA
| | - Josef M. Penninger
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, Vienna A-1030, Austria
- Department of Medical Genetics, Life Sciences Institute, UBC, Vancouver, BC V6T 1Z3, Canada
| | - Clifford J. Woolf
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA 02115, USA
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14
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Palermo G, Giannoni S, Bellini G, Siciliano G, Ceravolo R. Dopamine Transporter Imaging, Current Status of a Potential Biomarker: A Comprehensive Review. Int J Mol Sci 2021; 22:11234. [PMID: 34681899 PMCID: PMC8538800 DOI: 10.3390/ijms222011234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022] Open
Abstract
A major goal of current clinical research in Parkinson's disease (PD) is the validation and standardization of biomarkers enabling early diagnosis, predicting outcomes, understanding PD pathophysiology, and demonstrating target engagement in clinical trials. Molecular imaging with specific dopamine-related tracers offers a practical indirect imaging biomarker of PD, serving as a powerful tool to assess the status of presynaptic nigrostriatal terminals. In this review we provide an update on the dopamine transporter (DAT) imaging in PD and translate recent findings to potentially valuable clinical practice applications. The role of DAT imaging as diagnostic, preclinical and predictive biomarker is discussed, especially in view of recent evidence questioning the incontrovertible correlation between striatal DAT binding and nigral cell or axon counts.
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Affiliation(s)
- Giovanni Palermo
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (G.P.); (S.G.); (G.B.); (G.S.)
| | - Sara Giannoni
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (G.P.); (S.G.); (G.B.); (G.S.)
- Unit of Neurology, San Giuseppe Hospital, 50053 Empoli, Italy
| | - Gabriele Bellini
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (G.P.); (S.G.); (G.B.); (G.S.)
| | - Gabriele Siciliano
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (G.P.); (S.G.); (G.B.); (G.S.)
| | - Roberto Ceravolo
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (G.P.); (S.G.); (G.B.); (G.S.)
- Center for Neurodegenerative Diseases, Unit of Neurology, Parkinson’s Disease and Movement Disorders, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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15
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Politis A, Kokras N, Souvatzoglou M, Siarkos K, Toulas P, Potagas C, Hatzipanagiotou T, Limouris G, Alexopoulos P. Differences in cause and 12-month follow-up outcome of parkinsonian symptoms in depressed older adults treated with antipsychotics: a case series. BMC Psychiatry 2021; 21:289. [PMID: 34082747 PMCID: PMC8173873 DOI: 10.1186/s12888-021-03298-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/20/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Parkinsonian symptoms are common adverse effects of antipsychotics. Older adults are particularly vulnerable to drug-induced parkinsonism. Nonetheless, parkinsonian symptoms in seniors treated with antipsychotics cannot be straightforwardly attributed to antipsychotic medication. A comprehensive diagnostic workup is necessary in many cases in order to shed light on the cause of such symptoms in this patient population. CASE SERIES Eight cases of hospitalized depressed older adults with parkinsonian symptoms, who were treated for at least one year with antipsychotics, are reported. Based on neurological consultation, structural brain imaging and Ioflupane (I-123) dopamine transporter (DAT) single photon emission computerized tomography (SPECT), Parkinson's disease was diagnosed in one case, idiopathic tremor in another, vascular parkinsonism in another one, while in another individual parkinsonian symptoms persisted at 12-month post-discharge follow-up even though his/her symptoms were classified as drug-induced on discharge. In four patients, parkinsonian symptoms were definitely drug-induced and no movement disturbances were reported at follow-up. CONCLUSIONS Differences in the cause and outcome of parkinsonian symptoms in seniors treated with antipsychotics merit systematic and in-depth study considering the therapeutic and prognostic implications of an accurate detection of the cause of such symptoms. Familiarizing clinical psychiatrists with these differences could pave the way towards approaching seniors with severe, atypical and/or persistent parkinsonian symptoms in a more individualized diagnostic and therapeutic manner, and towards more cautious prescribing of antipsychotics in this age group.
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Affiliation(s)
- Anastasios Politis
- grid.7445.20000 0001 2113 8111Charing Cross Hospital, Department of Neurosurgery, Imperial College London, London, UK
| | - Nikolaos Kokras
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, Eginition Hospital; Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Souvatzoglou
- grid.5216.00000 0001 2155 0800Nuclear Medicine Division, Radiology First Department, “Aretaieion” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Siarkos
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Toulas
- grid.5216.00000 0001 2155 0800Research Unit of Radiology, Second Department of Radiology, National and Kapodistrian University of Athens and Bioiatriki, Athens, Greece
| | - Constantin Potagas
- grid.5216.00000 0001 2155 0800First Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Hatzipanagiotou
- grid.415451.00000 0004 0622 6078Department of Nuclear Medicine, Metropolitan Hospital, Neo Faliro, Pireas, Greece
| | - Georgios Limouris
- grid.5216.00000 0001 2155 0800Nuclear Medicine Division, Radiology First Department, “Aretaieion” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Alexopoulos
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, 26504 Rion, Patras, Greece. .,Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany.
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