Health Encyclopedia

Secondary parkinsonism

Definition

Secondary parkinsonism is when symptoms similar to Parkinson disease are caused by certain medicines, a different nervous system disorder, or another illness.

Parkinsonism refers to any condition that involves the types of movement problems seen in Parkinson disease. These problems include tremors, slow movement, and stiffness of the arms and legs.

Alternative Names

Parkinsonism - secondary; Atypical Parkinson disease

Causes

Secondary parkinsonism may be caused by health problems, including:

• Brain injury
• Diffuse Lewy body disease (a type of dementia)
• Encephalitis
• HIV/AIDS
• Meningitis
• Multiple system atrophy
• Progressive supranuclear palsy
• Stroke
• Wilson disease

Other causes of secondary parkinsonism include:

• Brain damage caused by anesthesia medicines (such as during surgery)
• Carbon monoxide poisoning
• Certain medicines used to treat mental disorders or nausea (for example, metoclopramide and prochlorperazine)
• Mercury poisoning and other chemical poisonings
• Overdoses of narcotics
• MPTP (a contaminant in some street drugs)

There have been rare cases of secondary parkinsonism among IV drug users who injected a substance called MPTP, which can be produced when making a form of heroin.

Symptoms

Common symptoms include:

• Decrease in facial expressions
• Difficulty starting and controlling movement
• Loss or weakness of movement (paralysis)
• Soft voice
• Stiffness of the trunk, arms, or legs
• Tremor

Confusion and memory loss may be likely in secondary parkinsonism. This is because many diseases that cause secondary parkinsonism also lead to dementia.

Exams and Tests

Your health care provider will perform a physical exam and ask questions about your medical history and symptoms. Be aware that the symptoms may be hard to assess, particularly in older adults.

Examination may show:

• Difficulty starting or stopping voluntary movements
• Tense muscles
• Problems with posture
• Slow, shuffling walk
• Tremors (shaking)

Reflexes are usually normal.

Tests may be ordered to check for other problems that can cause similar symptoms.

Treatment

If the condition is caused by a medicine, your provider may recommend changing or stopping the medicine.

Treating underlying conditions, such as stroke or infections, can reduce symptoms or prevent the condition from getting worse.

If symptoms make it hard to do everyday activities, your provider may recommend medicine. Medicines used to treat this condition can cause severe side effects. It is important to see your provider for check-ups. Secondary parkinsonism tends to be less responsive to medical therapy than Parkinson disease.

Outlook (Prognosis)

Unlike Parkinson disease, some types of secondary parkinsonism may stabilize or even improve if the underlying cause is treated. Some brain problems, such as Lewy body disease, are not reversible.

Possible Complications

This condition may lead to these problems:

• Difficulty doing daily activities
• Difficulty swallowing (eating)
• Disability (varying degrees)
• Injuries from falls
• Side effects of medicines used to treat the condition

Side effects from loss of strength (debilitation):

• Breathing food, fluid, or mucus into the lungs (aspiration)
• Blood clot in a deep vein (deep vein thrombosis)
• Malnutrition

When to Contact a Medical Professional

Contact your provider if:

• Symptoms of secondary parkinsonism develop, come back, or get worse.
• New symptoms appear, including confusion and movements that cannot be controlled.
• You are unable to care for the person at home after treatment starts.

Prevention

Treating conditions that cause secondary parkinsonism may decrease the risk.

People taking medicines that can cause secondary parkinsonism should be carefully monitored by the provider to prevent the condition from developing.

References

Fox SH, Katzenschlager R, Lim SY, et al; Movement Disorder Society Evidence-Based Medicine Committee. International Parkinson and Movement Disorder Society evidence-based medicine review: update on treatments for the motor symptoms of Parkinson's disease. Mov Disord. 2018;33(8):1248-1266. PMID: 29570866 pubmed.ncbi.nlm.nih.gov/29570866/.

Jankovic J. Parkinson disease and other movement disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 96.

Ostrem JL, Okun MS. Parkinsonism. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 378.

Pringsheim T, Day GS, Smith DB, et al; the American Academy of Neurology Guideline Subcommittee. Dopaminergic therapy for motor symptoms in early Parkinson disease practice guideline summary. Neurology. 2021;97(20). www.neurology.org/doi/10.1212/WNL.0000000000012868.

Review Date:1/23/2022
Reviewed By:Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Internal review and update on 07/18/2023 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.