Drug-Induced Movement Disorders and Parkinsonism

Drug-induced movement disorders encompass a range of involuntary motor disturbances precipitated by exposure to certain medications, most commonly dopamine-blocking agents such as antipsychotics and antiemetics. Parkinsonism is the predominant presentation, characterised by bradykinesia, rigidity, resting tremor and postural instability. Other syndromes include acute dystonia, akathisia, tardive dyskinesia and myoclonus. The pathogenesis typically involves antagonism of dopamine D2 receptors in the nigrostriatal pathway, although emerging evidence implicates wider disruptions of cholinergic, GABAergic and adenosinergic systems. Clinical onset may be rapid or develop insidiously after months to years of treatment, and recovery ranges from complete resolution upon drug withdrawal to persistent deficits requiring symptomatic therapy. Risk factors include older age, female sex, high-potency or long-duration exposure and underlying subclinical neurodegenerative pathology. Diagnosis rests on careful drug history, neurological examination and, where available, neuroimaging of presynaptic dopamine transporters. Management strategies emphasise minimising causative agents, dose reduction or switching to lower-risk alternatives, combined with symptomatic interventions such as anticholinergics or levodopa. Recognition of drug-induced parkinsonism is critical for preventing permanent disability and refining safer prescribing guidelines.

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Drug-Induced Movement Disorders and Parkinsonism publication trend

The graph below shows the total number of articles in drug-induced movement disorders and parkinsonism across all publications each year (not limited to Nature Index journals).

Technical terms

Parkinsonism: A clinical syndrome of bradykinesia, rigidity, tremor and postural instability that mimics Parkinson’s disease but may arise from drugs or other causes.

Extrapyramidal symptoms: Motor disturbances—including dystonia, akathisia and parkinsonism—resulting from disruption of basal ganglia circuits by pharmacological agents.

Dopamine D2 receptor antagonist: A medication class, primarily antipsychotics, that blocks dopamine D2 receptors in the brain and can precipitate parkinsonian side effects.

Dopamine transporter imaging: A neuroimaging modality assessing presynaptic dopamine transporter availability to distinguish drug-induced changes from neurodegenerative processes.

References

1. Pathophysiological Mechanisms of Antipsychotic-Induced Parkinsonism. Biomedicines (2022).
2. Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review. Medicines (2021).
3. Use of antipsychotics and long-term risk of parkinsonism. Neurological Sciences (2021).