Parkinsonism Caused By Adverse Drug Reactions: A Case Series
Parkinsonism Caused By Adverse Drug Reactions: A Case Series
Introduction: Parkinsonism puts a high direct cost burden on both patient and caregiver. 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.
Case presentation: We describe two cases of parkinsonism possibly caused by adverse drug reaction to quinine in a 29-year-old black Nigerian woman and to halothane in a 36-year-old black Hausa (Nigerian) man who received it as general anaesthesia for appendicectomy in our teaching hospital.
Conclusion: These are two unusual cases of parkinsonism caused by adverse drug reactions to high-dose quinine and to halothane as general anaesthesia. We consider that these two cases are important in bringing this potential side-effect to the attention of both pharmacologists and primary care physicians as these are two of the most commonly used medications in our clinics. We conclude that parkinsonism should be included among the adverse drug reactions to high-dose quinine and halothane general anaesthetic.
The most common cause of parkinsonism is Parkinson's Disease (PD), accounting for approximately 77.7% of cases, followed by parkinsonism-plus syndrome (12.2%). Secondary causes such as drugs, trauma, vascular conditions, acquired immunodeficiency disease and toxins make up around 8.2%, and the remaining 0.6% of cases are classified as Heredodegenerative parkinsonism.
Quinine was the first antimalarial drug available, which has been in use since the 17th century. Quinine is a natural white crystalline alkaloid with antipyretic effects. It is a stereoisomer of quinidine, which has an antiarrhythmic effect. Side effects of quinine include cinchonism, pulmonary oedema, abnormal heart rhythms and hearing impairment. Contrary to popular belief, quinine is an ineffective abortifacient, and is recommended by World Health Organization (WHO) for use in pregnancy. The mechanism of action of quinine is still elusive but the most popular hypothesis is inhibition of hemozoin biocrystallization leading to formation of cytotoxic heme, which accumulates within the malaria parasites and causes their death.
Halothane is an inhalational anaesthetic agent, chemically designated 2-bromo-2-chloro-1,1,1-trifluoroethane. Halothane anaesthesia augments the action of nondepolarizing skeletal muscle relaxants and ganglionic blocking agents, and is also a potent uterine relaxant. The side effects include hepatic necrosis, cardiac and respiratory arrest, hypotension, cardiac arrhythmias, hyperpyrexia, shivering, nausea and emesis.
Several drugs and toxins have been reported to cause parkinsonism, but to the best of our knowledge, there has been no report of parkinsonism induced by quinine or halothane. The aetiology of PD is still elusive, although a combination of environmental and genetic factors is implicated. The anatomy of the basal ganglia consists of group of nuclei situated in the deep part of the cerebrum and upper part of the brain stem. The neurophysiological changes in the basal ganglia responsible for parkinsonism are mainly neuronal loss in the substantia nigra with consequent dopamine depletion in the striatum. Evidence is accumulating about mechanisms by which drugs and toxins cause parkinsonism. They act on particular steps in the formation, storage in presynaptic vesicles, release, uptake, catabolism and re-synthesis of neurotransmitters such as dopamine, serotonin, norepinephrine, acetylcholine and other catecholamines.
Abstract and Introduction
Abstract
Introduction: Parkinsonism puts a high direct cost burden on both patient and caregiver. 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.
Case presentation: We describe two cases of parkinsonism possibly caused by adverse drug reaction to quinine in a 29-year-old black Nigerian woman and to halothane in a 36-year-old black Hausa (Nigerian) man who received it as general anaesthesia for appendicectomy in our teaching hospital.
Conclusion: These are two unusual cases of parkinsonism caused by adverse drug reactions to high-dose quinine and to halothane as general anaesthesia. We consider that these two cases are important in bringing this potential side-effect to the attention of both pharmacologists and primary care physicians as these are two of the most commonly used medications in our clinics. We conclude that parkinsonism should be included among the adverse drug reactions to high-dose quinine and halothane general anaesthetic.
Introduction
The most common cause of parkinsonism is Parkinson's Disease (PD), accounting for approximately 77.7% of cases, followed by parkinsonism-plus syndrome (12.2%). Secondary causes such as drugs, trauma, vascular conditions, acquired immunodeficiency disease and toxins make up around 8.2%, and the remaining 0.6% of cases are classified as Heredodegenerative parkinsonism.
Quinine was the first antimalarial drug available, which has been in use since the 17th century. Quinine is a natural white crystalline alkaloid with antipyretic effects. It is a stereoisomer of quinidine, which has an antiarrhythmic effect. Side effects of quinine include cinchonism, pulmonary oedema, abnormal heart rhythms and hearing impairment. Contrary to popular belief, quinine is an ineffective abortifacient, and is recommended by World Health Organization (WHO) for use in pregnancy. The mechanism of action of quinine is still elusive but the most popular hypothesis is inhibition of hemozoin biocrystallization leading to formation of cytotoxic heme, which accumulates within the malaria parasites and causes their death.
Halothane is an inhalational anaesthetic agent, chemically designated 2-bromo-2-chloro-1,1,1-trifluoroethane. Halothane anaesthesia augments the action of nondepolarizing skeletal muscle relaxants and ganglionic blocking agents, and is also a potent uterine relaxant. The side effects include hepatic necrosis, cardiac and respiratory arrest, hypotension, cardiac arrhythmias, hyperpyrexia, shivering, nausea and emesis.
Several drugs and toxins have been reported to cause parkinsonism, but to the best of our knowledge, there has been no report of parkinsonism induced by quinine or halothane. The aetiology of PD is still elusive, although a combination of environmental and genetic factors is implicated. The anatomy of the basal ganglia consists of group of nuclei situated in the deep part of the cerebrum and upper part of the brain stem. The neurophysiological changes in the basal ganglia responsible for parkinsonism are mainly neuronal loss in the substantia nigra with consequent dopamine depletion in the striatum. Evidence is accumulating about mechanisms by which drugs and toxins cause parkinsonism. They act on particular steps in the formation, storage in presynaptic vesicles, release, uptake, catabolism and re-synthesis of neurotransmitters such as dopamine, serotonin, norepinephrine, acetylcholine and other catecholamines.
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