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Drug-Induced Parkinsonism: A Structured, Mechanism-Informed Approach to Identification and Management.
Beatriz De Faria Sousa1, Juan B Espinosa2,3
1College of Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Drug-induced parkinsonism (DIP) is a reversible condition mimicking Parkinson's disease, often caused by medications and supplements. Early recognition and drug withdrawal are key to recovery.
Area of Science:
- Neurology
- Pharmacology
- Clinical Medicine
Background:
- Drug-induced parkinsonism (DIP) is an underrecognized secondary parkinsonism.
- It can mimic idiopathic Parkinson's disease but is often reversible.
- Newer agents like valproate and herbal supplements contribute to DIP.
Purpose of the Study:
- To synthesize data on DIP from 2009-2025.
- To provide a structured, mechanism-informed clinical approach for DIP.
- To enhance clinician education and detection of preventable DIP.
Main Methods:
- Narrative review of epidemiologic, mechanistic, and clinical data.
- Analysis of studies on causes, prevalence, and diagnostic features of DIP.
- Synthesis of evidence for a three-step clinical management approach.
Main Results:
- DIP accounts for 15-20% of secondary parkinsonism, affecting older adults and women disproportionately.
- Dopamine transporter imaging often shows preserved striatal uptake, differentiating DIP from neurodegenerative parkinsonism.
- Recovery typically occurs within 6-12 months after drug withdrawal, though some may have persistent symptoms.
Conclusions:
- A three-step approach (medication review, pattern recognition, withdrawal) aids DIP management.
- This framework supports safer prescribing and enhances detection of this preventable condition.
- Timely intervention and follow-up are crucial for confirming reversibility.

