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Disabling parkinsonism due to lithium: a case report

S Holroyd1, D Smith

  • 1Department of Psychiatric Medicine, University of Virginia, School of Medicine, Charlottesville, USA.

Journal of Geriatric Psychiatry and Neurology
|April 1, 1995
PubMed
Summary

Lithium carbonate can cause parkinsonism, a disabling neurologic condition, in elderly patients. Symptoms resolved upon lithium discontinuation and reappeared at higher serum levels, suggesting dose-dependent toxicity.

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Area of Science:

  • Neurology
  • Pharmacology

Background:

  • Lithium carbonate is a mood stabilizer used in treating bipolar disorder.
  • Parkinsonism is a neurological disorder characterized by tremors, rigidity, and slow movement.
  • Previous reports link lithium treatment to parkinsonism, often with other signs of toxicity.

Observation:

  • An elderly female developed disabling parkinsonism during lithium carbonate treatment.
  • The patient exhibited no other symptoms of lithium toxicity.
  • Neurologic symptoms resolved completely after discontinuing lithium.

Findings:

  • Resuming lithium at serum levels below 0.7 mmol/L caused no recurrence of symptoms.
  • Mild parkinsonian symptoms returned when serum lithium levels reached 0.7 to 0.9 mmol/L.
  • Older age, prolonged lithium treatment, and high therapeutic levels may increase the risk of lithium-induced parkinsonism.

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Implications:

  • Clinicians should monitor elderly patients on lithium for parkinsonian symptoms.
  • Careful titration and monitoring of serum lithium levels are crucial to prevent neurotoxicity.
  • This case highlights the potential for lithium-induced parkinsonism as a specific side effect, independent of general toxicity.