Fluphenazine-Induced Neurotoxicity with Acute Almost Transient Parkinsonism and Permanent Memory Loss: Lessons from a...

Area of Science:

• Neuroscience
• Pharmacology
• Neurology

Background:

• First-generation antipsychotics, like Fluphenazine, are associated with extrapyramidal symptoms (EPS).
• Drug-induced parkinsonism typically develops gradually.
• The neurotoxicity of these agents is debated, with theories of differential susceptibility to CNS stressors.

Observation:

• A 31-year-old woman developed severe Fluphenazine-induced parkinsonism within days due to an erroneous prescription (indication and dosage).
• She presented with acute extrapyramidal syndrome (EPS), including motor and sphincter dysfunction.
• Despite incomplete recovery over six months, residual symptoms included hypomimia, left hemiparkinsonism, and memory disturbances.

Findings:

• Brain MRI revealed a 6.5% loss in brain volume, with cortical and sub-cortical grey matter reduction and cerebrospinal fluid space enlargement.
• White matter remained spared.
• DaTScan and other investigations were negative, suggesting non-dopaminergic mechanisms or subtle structural changes.

Implications:

• This case suggests Fluphenazine can cause acute parkinsonism with potential neurotoxic effects on grey matter, leading to irreversible deficits.
• The findings support the neurotoxicity of first-generation antipsychotics and highlight differential susceptibility to cytotoxic effects in the CNS.
• This underscores the importance of accurate drug prescription and monitoring for potential adverse neurological effects.