Drug-Induced Parkinsonism and Neuroleptic Malignant Syndrome: A Case Report

Alexey A. Tappakhov, Tatiana E. Popova, Yulia I. Khabarova, Maria V. Yakovleva, Alina E. Adamova, Tatiana G. Govorova, Michil E. Andreev

International Journal of Biomedicine. 2020;10(2):174-177.
DOI: 10.21103/Article10(2)_CR
Originally published June 15, 2020.


The article presents a clinical case of neuroleptic malignant syndrome (NMS) and DIP after a single dose of thiorizadine, and discusses the issues of differential diagnosis and treatment methods. A 57-year-old patient with long-term remission of schizophrenia due to insomnia was prescribed thiorizadine. After a single dose, symptoms of parkinsonism in the form of hypokinesia, muscle rigidity and bradyphrenia developed and began to progress. Three weeks later NMS developed, and treatment was carried out in the intensive care unit. When signs of parkinsonism persisted, she was hospitalized in the neurological department. Regression of symptoms occurred by her taking amantadine sulfate.

neuroleptic malignant syndrome • drug-induced parkinsonism • antipsychotic drugs • Parkinson’s disease
  1. Danilov DS. [Benzamide neuroleptics in the practice of a psychiatrist, a neurologist, and an internist at the present development stage of psychopharmacology (by the example of sulpiride)]. Nevrologiya, Neyropsikhiatriya, Psikhosomatika. 2012;4(3):77-85. doi: 10.14412/2074-2711-2012-410. [Article in Russian].
  2. Steck H. [Extrapyramidal and diencephalic syndrome in the course of largactil and serpasil treatments]. Ann Med Psychol (Paris). 1954;112(25):737-44. [Article in French].
  3. Bergouignan M, Regnier G. [Reversible parkinsonism in the course of largactil therapy of vomiting in pregnancy]. J Med Bord. 1954;131(7):678-679. [Article in French].
  4. Levin OS, Shindryaeva NN, Anikina MA. [Drug-induces parkinsonism]. Zh Nevrol Psikhiatr Im S S Korsakova. 2012;112(8):76-81. [Article in Russian].
  5. Blanchet P, Kivenko V. Drug-induced parkinsonism: diagnosis and management. J Park Restless Legs Syndr. 2016;6:83-91. doi: 10.2147/JPRLS.S99197.
  6. Nodel MR. [Drug-induced parkinsonism: risk minimization options] Nervnye Bolezni. 2015;3:18-22. [Article in Russian].
  7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; 2013. doi: 10.1176/appi.books.9780890425596.
  8. Bondon-Guitton E, Perez-Lloret S, Bagheri H, Brefel C, Rascol O, Montastruc J-L. Drug-induced parkinsonism: a review of 17 years’ experience in a regional pharmacovigilance center in France. Mov Disord. 2011;26(12):2226-2231. doi: 10.1002/mds.23828.
  9. Esper CD, Factor SA. Failure of recognition of drug-induced parkinsonism in the elderly. Mov Disord. 2008;23(3):401-404. doi: 10.1002/mds.21854.
  10. Malin DI. [Malignant antipsychotic syndrome: diagnosis and therapy]. Sovremennaya Terapiya Psikhicheskikh Rasstroystv. 2016;2:2-9. doi: 10.21265/PSYPH.2016.0.1757. [Article in Russian].
  11. Pileggi DJ, Cook AM. Neuroleptic Malignant Syndrome. Ann Pharmacother. 2016;50(11):973-981. doi: 10.1177/1060028016657553.
  12. Duma SR, Fung VS. Drug-induced movement disorders. Aust Prescr. 2019;42(2):56-61. doi: 10.18773/austprescr.2019.014.
  13. Fedorova NV, Vetokhina TN. [Diagnosis and treatment of antipsychotic extrapyramidal syndromes]. Psikhicheskie Rasstroystva v Obshchey Meditsine. 2009;3:18-24. [Article in Russian].
  14. Thanvi B, Treadwell S. Drug induced parkinsonism: a common cause of parkinsonism in older people. Postgrad Med J. 2009;85(1004):322-326. doi: 10.1136/pgmj.2008.073312.
  15. Brigo F, Erro R, Marangi A, Bhatia K, Tinazzi M. Differentiating drug-induced parkinsonism from Parkinson’s disease: An update on non-motor symptoms and investigations. Parkinsonism Relat Disord. 2014;20(8):808-814. doi: 10.1016/j.parkreldis.2014.05.011.
  16. Foubert-Samier A, Helmer C, Perez F, Le Goff M, Auriacombe S, Elbaz A, et al. Past exposure to neuroleptic drugs and risk of Parkinson disease in an elderly cohort. Neurology. 2012;79(15):1615-1621. doi: 10.1212/WNL.0b013e31826e25ce.
  17. López-Sendón JL, Mena MA, de Yébenes JG. Drug-induced parkinsonism in the elderly: incidence, management and prevention. Drugs Aging. 2012;29(2):105-118. doi: 10.2165/11598540-000000000-00000.
  18. Kim JS, Oh YS, Kim YI, Yang DW, Chung YA, You IR, et al. Combined use of 123I-metaiodobenzylguanidine (MIBG) scintigraphy and dopamine transporter (DAT) positron emission tomography (PET) predicts prognosis in drug-induced Parkinsonism (DIP): a 2-year follow-up study. Arch Gerontol Geriatr. 2013;56(1):124-128. doi: 10.1016/j.archger.2012.05.001.
  19. Vlaar AMM, de Nijs T, Kessels AGH, Vreeling FW, Winogrodzka A, Mess WH, et al. Diagnostic value of 123I-ioflupane and 123I-iodobenzamide SPECT scans in 248 patients with parkinsonian syndromes. Eur Neurol. 2008;59(5):258-266. doi: 10.1159/000115640.
  20. Anikeev LM, Anikeeva LV. ]The experience of using PK-Merz in antipsychotic syndrome in a psychiatric hospital]. Effektivnaya Farmakoterapiya. 2011;19:32. [Article in Russian].
  21. Tse L, Barr A, Scarapicchia V, Vila-Rodriguez F. Neuroleptic Malignant Syndrome: A Review from a Clinically Oriented Perspective. Curr Neuropharmacol. 2015;13(3):395-406. doi: 10.2174/1570159x1399915042411334.
  22. Trollor JN, Chen X, Chitty K, Sachdev PS. Comparison of neuroleptic malignant syndrome induced by first- and second-generation antipsychotics. Br J Psychiatry. 2012;201(1):52-56. doi: 10.1192/bjp.bp.111.105189.
  23. Barylnik YuB, Filippova NV, Antonova AA, Guseva MA, Magomedova MS. [Malignant neuroleptic syndrome in the treatment of atypical antipsychotics (review)]. Psikhiatriya i psikhofarmakoterapiya im P.B Gannushkina. 2017; 2: 24-26. [Article in Russian].
  24. Su YP, Chang CK, Hayes RD, Harrison S, Lee W, Broadbent M, et al. Retrospective chart review on exposure to psychotropic medications associated with neuroleptic malignant syndrome. Acta Psychiatr Scand. 2014;130(1):52-60. doi: 10.1111/acps.12222.
  25. Viejo LF, Morales V, Puñal P, Pérez JL, Sancho RA. Risk factors in neuroleptic malignant syndrome. A case-control study. Acta Psychiatr Scand. 2003; 107(1): 45-49. Doi: 10.1034/j.1600-0447.2003.02385.x.
  26. Arkhipov VV, Berdnikova NG, Zhuravleva MV, Kukes VG. [A retrospective analysis of a case of an adverse reaction - a malignant neuroleptic syndrome in the use of haloperidol]. Bezopasnost' i risk farmakoterapii. 2015; 2: 30-39. [Article in Russian].

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Received April 21, 2020.
Accepted May 23, 2020.
©2020 International Medical Research and Development Corporation.