Ji sun kim, jinyoung youn, hyeeun shin and jin whan cho, nonmotor symptoms in druginduced parkinsonism and drugnaive parkinson disease, canadian journal of neurological sciences journal canadien des sciences neurologiques, 10. Among the most common of the former type are essential tremor, enhanced physiologic tremor, drug induced tremor, dystonic tremor, orthostatic tremor, and. Pdf parkinsonism, tremor, choreaballismus, dystonia, tardive dyskinesia, myoclonus, tics and akathisia can be induced by many drugs. Introduction a method of studying possible anatomical substrates involved in the production of a resttype tremor has been provided by use of the drug tremorine 1,4dipyrrolidino2butyne2 in the cat. This occurs with voluntary muscle contraction and includes postural, kinetic, and isometric tremor. A druginduced tremor is a tremor thats caused by taking a drug. Titubation is a type of essential tremor, which is a nervous system disorder that causes uncontrollable, rhythmic shaking. The clinician should then formulate two sets of differential diagnoses. The advent of modern synthetic drugs has brought to light many more, and tremor is a frequently reported side. Most of the drugs cause postural tremor, although many drugs can also cause resting and intention tremors. Insights into pathophysiology from medicationinduced tremor ncbi. Most drugs acting on the central nervous system can produce tremor as a sideeffect findley and gresty, 1981 to the extent that the standard psychopharmacological evaluation scales for sideeffects in. Drug induced tremor tremor can be a side effect of prescription medications, such as betaadrenoceptor agonists, valproic acid, thyroxine, tricyclic antidepressants, selective serotonin reuptake inhibitors, amiodarone, procainamide, methylxanthines. Pdf background medicationinduced tremor mit is common in clinical practice and there are many.
A tremor is a rhythmic, uncontrollable movement of part of your body. It is symmetrical and occurs acutely following drug ingestion or dose escalation. Drug induced tremors are a muscular response to certain drugs or medications. If the tremor inducing drug cannot be discontinued, the tremor may be treated with a symptomatic medication, such as propranolol, which is effective in some cases of drug induced action tremor. Drug induced parkinsonism is more prevalent in older people and is twice as common in women than men. The tremor is most commonly in the hands, but may affect the head, eyelids, vocal. Caffeine and betaadrenergic agonists are wellrecognised drugs that cause or exacerbate tremors.
Sep 21, 2007 the use of certain medications can result in shaking when moving or attempting to move. Introduction a method of studying possible anatomical substrates involved in the production of a resttype tremor has been provided by use of the drug tremorine 1,4dipyrrolidino2butyne 2 in the cat. Tremor commonly occurs with lithium treatment and occasionally chorea. Recognition of the drugs that can cause or exacerbate tremors can help prompt diagnosis, avoids unnecessary tests, and. Click on the image or right click to open the source website in a new browser window. This specific druginduced parkinsonism dip mimics idiopathic parkinsons disease with the typical parkinsonian triad but the symptomatology of this disorder is a rather akinetic rigid syndrome with lesser incidence of resting tremor.
Drug induced tremor commonly occurs after use of sympatho mimetics such as pseudoephedrine, bronchodilators, or theo phylline, and antidepressants such as tricyclics or fluoxetine. Drug induced tremor is involuntary shaking due to the use of medicines. Aug 14, 2017 drug induced extrapyramidal symptoms scale diepss is developed in the era of secondgeneration antipsychotics and is suitable for evaluation of the low incidence of extrapyramidal symptoms. The first step in the evaluation of a patient with tremor is to categorize the tremor based on its. The management of tremor journal of neurology, neurosurgery. Exceptions include tremor secondary to valproate, which can appear at therapeutic or during stable treatment, or, rarely, tardive tremor. Patients at risk there are multiple risk factors for drug induced tremor, older age being the most important. A temporal association with the start of pharmacotherapy and onset of tremor is useful in establishing the diagnosis of drug induced tremor. Seizure medicines such as valproic acid depakote and sodium valproate depakene asthma medicines such as theophylline and albuterol. Patients with drug induced resting tremor as a part of dip should be taken off dopamineblocking agents if possible, or switched to a more atypical agent. Prescribed drugs and neurological complications journal. Approximately 25% of patients taking valproate are found to develop tremors within 312 months of initiating therapy. Reports dealing with an analysis of the tremor producing properties of this compound have been primarily those of everett et al. We describe two cases of parkinsonism possibly caused by adverse drug reaction to quinine in a 29yearold black nigerian woman and to.
Parkinsonism, tremor, choreaballismus, dystonia, tardive dyskinesia, myoclonus, tics and akathisia can be induced by many drugs. Periodic monitoring for movement disorders is a component of comprehensive mental health care. Movement disorders induced by neuroleptics are divided into three time periods. Druginduced movement disorders movement disorder society. The use of neuroleptics as psychotherapeutic agents has resulted in extrapyramidal syndromes including parkinsonism. Other tremorogenic drugs, such as selective serotonin reuptake inhibitors and tricyclic antidepressants, are less well recognised. Drug induced parkinsonism dip is the secondmostcommon etiology of parkinsonism in the elderly after parkinsons disease pd. Pdf insights into pathophysiology from medicationinduced tremor. Lithium treatment commonly induces tremor and occasionally chorea. Neurology a tremor, typically worsened with activity and purposeful movement, unassociated with other sx, caused by a drug or medication agents lithium carbonate, theophylline, alupent, cyclosporine, and stimulantseg, caffeine. Drug induced tremors drug induced tremors are also not uncommon and may cause rest or action tremor dependent on the drug.
Reports dealing with an analysis of the tremor producing properties of this compound have. These images are a random sampling from a bing search on the term drug induced tremor. In majority of the cases, the tremor disappears after stopping the drug. Prescrire 1 february 2018 drug induced tremor prescrire int 2018. Tremor, rigidity, bradykinesia, and less commonly postural instability are common features. Current drugs prescribed, over the counter, herbal remedies, drugs of misuse and how they are taken frequency, timing, missed and extra doses, drugs tried previously and reason for discontinuation, treatment response, adverse effects, allergies, and intolerances should be taken into account. There may be a genetic predisposition to drug induced parkinsonism. Prescribed drugs and neurological complications journal of.
Diagnosis and management of tremor movement disorders. The drugs that are most frequently implicated in movement. In contrast to other publications focusing on disorders of hypokinesia i. Drug induced tremors are generally doseresponsive ie, increasing the drug dose worsens the tremor, or decreasing the dose ameliorates the tremor and lack of progression, unlike tremors in.
Due to medications that affect presynaptic, synaptic, or postsynaptic dopamine levels. Please note that some products on the essential tremor international site are not approved for use in the us and that indications for use of approved products may be different in the us and internationally. Other risk factors include a family history of parkinsons and affective disorders. Druginduced extrapyramidal symptoms scale diepss serbian. Prescrire 1 february 2018 druginduced tremor prescrire int 2018. Drug induced tremor may produce a resting tremor e. Druginduced tremor is a simple nervous system and muscle response to certain medicines. Differentiating druginduced parkinsonism from parkinsons disease. A treatment history is a fundamental part of the healthcare consultation. Development of a fine hand tremor by patients initiating treatment with lithium is a wellknown and anticipated side effect. Patients and prescribers should be alert for neuropsychiatric events. Druginduced tremor penn state hershey medical center.
List of benign essential tremor medications 8 compared. Sometimes, this will reduce or even stop the tremors, thus avoiding the prescription of antitremor medication, such as antiparkinsonians, which in turn expose patients to various adverse effects. Druginduced tremor is an important differential diagnosis for tremor syndromes. Ept is the most common drug induced tremor and many patients have previously unnoticed. Tremors are one of the common side effects of certain antiepileptics, commonly sodium valropate. Incidence of lithium induced tremor ranges widely from 465%. Several reports of drug induced parkinsonism have been published, but to the best of our knowledge, there has not been any report of quinine or halothane inducing parkinsonism. Drug induced tremor may also enhance normal physiologic tremor or pathological tremors. Evaluation of patients with tremor practical neurology.
Drug induced parkinsonism clinically indistinguishable from idiopathic parkinsons disease. Resting tremor tremor the national tremor foundation. Drug induced tremor psychogenic tremor dystonic tremor cerebellar tremor metabolic tremor physiologic tremor prevalence 100% all of us will have some tremor at some point in our liv es this en subtle and fast is oft ually present in the upper limbs us. Sometimes, this will reduce or even stop the tremors, thus avoiding the prescription of anti tremor medication, such as antiparkinsonians, which in turn expose patients to various adverse effects. The advent of modern synthetic drugs has brought to light many more, and tremor is a frequently reported sideeffect of drug treatment. The phenomenological classification of tremor is determined by finding out. Tremor is defined as a rhythmical, involuntary oscillatory movement of a body part.
Drug induced tremor definition drug induced tremor is involuntary shaking due to the use of medicines. Differential diagnosis of tremors linkedin slideshare. The development of parkinsonism also increases the likelihood of akathisia developing, although the latter may occur. There are a range of underlying aetiological mechanisms. Druginduced movement disorders mental health clinician. Druginduced tremor is involuntary shaking due to the use of medicines. Drug induced tremor is typically postural or kinetic, or both. These agents are used for mood stabilization, and both drugs can produce a tremor that is. Anxious patient treatment of the anxiety drug induced decrease the dose or stop the drug. Lithium and valproic acid are among the more common offenders. Many patients with dip may be misdiagnosed with pd because the clinical features of these two conditions are indistinguishable.
Drug induced tremor is a simple nervous system and. Drugs are a common cause of tremor and may produce a wide variety. The most common causes of postural tremor are physiological tremor, essential tremor and druginduced tremor. The clinical course of a druginduced acute dystonic reaction. Two cases are reported in which a transient tremor of the tongue followed treatment with thioridazine and flunarizine. At times, the responsible party for implementing or maintaining side effect monitoring may not be clearly defined within the service. The shaking occurs when you move or try to hold your arms, hands, or head in a certain position. Significant proportion of druginduced movement disorders is related to antipsychotic medications and neuroleptics are the commonest. Similarly insulin, by inducing hypoglycaemia, can precipitate enhanced physiological tremor in diabetic patients. This can include tremor due an idiosyncratic effect of the medications, a toxicoverdose phenomenon, a drug induced parkinsonism and as part of a tardive disorder. Downloaded from the american family physician web site at. Tremor is a relatively common feature of the pharmacological action of a wide variety of substances. Druginduced parkinsonism is the second most common cause of. Essential tremor et has a gradual onset of 4 to 12 hz postural upper limb tremor less commonly head or voice, with no other neurologic signs except for cogwheeling.
The finding of this kyperkinesia as the only extrapyramidal sideeffect of drug therapy is uncommon. Medicationinduced tremor mit is common in clinical practice and there are many medicationsdrugs that can cause or exacerbate tremors. The following definitions are used to describe the various tremor components evident on examination1. Drug induced tremor describes a heterogeneous group of tremors caused by a variety of drugs. Other types of tremor are cerebellar, dystonic, drug or metabolic induced, and orthostatic. Although harmaline tremor is a well known animal model of et, it has not found utility as a preclinical drug screen and has not been validated with anti. Haloperidol and phenothiazine neuroleptics are drugs commonly associated with various dimds. Examples are physiologic tremor, essential tremor, certain drug induced tremors, and postural tremor of parkinson disease. When not associated with other symptoms, this is generally referred to as drug induced tremor.
Involuntary means you shake without trying to do so and cant stop when you try. The risk increases with higher drug doses, rapid increment of the dosage, and higher potency of the drug. Head tremors are linked to involuntary muscle contractions. Druginduced parkinsonism dip is the secondmostcommon etiology of parkinsonism in the elderly after parkinsons disease pd. Drug induced tremor is symmetric for most drugs, but in the setting of drug induced parkinsonism dip, patients commonly develop unilateral resting tremor. Pharmacotherapies are a common cause of tremor and multifocal myoclonus often confounded with tremor. Parkinsonism is due to drugs other than typical antipsychotics 2,42. The incidence of drug induced parkinsonism increases with age. Postural tremor is produced by voluntary maintenance of a particular posture held against gravity. Druginduced movement disorders australian prescriber. Street, suite 800 mia, florida 331mi 59 broadway, suite 1509 n, new york ew york 10018 helpline. Cancer medicines such as thalidomide and cytarabine. Essential tremors from meateating essential tremor et, a type of involuntary shaking with no known cause, is among the most prevalent neurological diseases, affecting 4. The shaking movement created by tremors is usually quick.
Pdf a practical guide to the differential diagnosis of tremor. Drug induced movement disorders are a mental health concern. Drugs and medications that can cause tremors include. Lithium and valproateinduced tremors mental health. Drug induced tremor is a simple nervous system and muscle response to certain medicines. Druginduced tremor information mount sinai new york. Parkinsonism puts a high direct cost burden on both patient and caregiver. Druginduced tremor definition of druginduced tremor by. Metabolic etiology eg, thyroid, glucose treated accordingly.