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Parkinsonism in elderly patients: 2 case reports Two patients developed parkinsonism during treatment with dopamine receptor blocking agents. One patient received risperidone, and the other patient received metoclopramide [routes not stated]. An 84-year-old man experienced a fall and fractured his ribs in October 2010. He was hospitalised. During his admission, he was started on risperidone 1mg twice daily for depression. Following discharge, he experienced progressive worsening of rigidity, gait, bradykinesia and balance problems [duration of treatment to reaction onset not stated]. Later on, he needed to use a cane and then a walker. He also experienced drooling and a softer voice. He started receiving levodopa/carbidopa, but it made him sleepy and fatigued. He was seen at a movement disorders centre in February 2011. He had been using risperidone for the past 5 months. Risperidone was withdrawn. Later, levodopa was withdrawn. At last follow-up, he was able to walk without a cane. However, he still had mild bradykinesia, mild rigidity, small stride, stooped posture, shuffling gait and decreased arm swing. A 77-year-old woman presented with generalised slowness, shuffling gait, voice softness, small handwriting and hand tremors for the past 2 years. She found it difficult to turn in bed at night and to get up from a chair. Over the past 3 months, she had fallen spontaneously on four occasions. For the past 10 years, she had been taking metoclopramide 20mg daily for "acid reflux disease". Upon examination, she also had a mildly diminished facial expression, cogwheel rigidity of her wrists, and a stooped posture. Metoclopramide was withdrawn. Subsequently, she was started on levodopa/carbidopa but was unable to tolerate the medication. Her symptoms improved slightly and continued to improve, but her parkinsonism had not resolved completely at last follow-up. Author comment: "The first case is a patient who developed parkinsonism from risperidone, while the second case developed parkinsonism from metoclopramide." Lim TT, et al. Is 6 months of neuroleptic withdrawal sufficient to distinguish druginduced parkinsonism from parkinson’s disease?. International Journal of Neuroscience 123: 170-174, No. 3, Mar 2013. Available from: URL: http:// 803085889 dx.doi.org/10.3109/00207454.2012.732976 - USA

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Reactions 20 Apr 2013 No. 1448