Trimetazidine and parkinsonism: A prospective study.

Aged Antiparkinson Agents / adverse effects Female Humans Male Middle Aged Parkinson Disease / drug therapy Parkinsonian Disorders / drug therapy Prospective Studies Tremor / drug therapy Trimetazidine / pharmacology
Drug-induced neurological side effects Movement disorders Reversible trimetazidine-induced parkinsonism Subclinical neurodegenerative parkinsonism Trimetazidine

Journal

Parkinsonism & related disorders
ISSN: 1873-5126
Titre abrégé: Parkinsonism Relat Disord
Pays: England
ID NLM: 9513583

Informations de publication

Date de publication:
05 2019
Historique:
received: 12 09 2018
revised: 03 01 2019
accepted: 03 01 2019
pubmed: 15 1 2019
medline: 2 6 2020
entrez: 15 1 2019
Statut: ppublish

Résumé

Although trimetazidine may induce parkinsonian symptoms in some patients, no systematic characterization has been reported on parkinsonism occurring during trimetazidine treatment since the first case reports. To systematically investigate parkinsonism occurring during trimetazidine use. Thirty-three consecutive patients on trimetazidine treatment with previously unrecognized parkinsonian symptoms were enrolled. Detailed neurological and neuropsychological examinations were performed at baseline and 1 and 12 months after trimetazidine withdrawal. In cases with persisting parkinsonian symptoms and suspected de novo Parkinson's disease, antiparkinsonian treatment was initiated. Twenty of the 33 patients underwent DaTSCAN imaging. After trimetazidine withdrawal, parkinsonism was completely resolved in 11 cases. The comparison of baseline data of patients with reversible and persisting parkinsonism showed that trimetazidine-induced reversible parkinsonism was mainly characterized by akinesia, rigidity, postural instability and gait disturbances (PIGD; PIGD scores: 5.3 ± 3.8 vs. 2.0 ± 1.6 points, p = 0.006) rather than tremors (tremor scores: 1.5 ± 2.2 vs. 7.7 ± 4.6 points, p = 0.000). Trimetazidine-induced reversible parkinsonism was also more symmetrical (asymmetry index: 3.1 ± 3.6 vs. 40.1 ± 22.2, p = 0.000) and milder in severity (MDS-UPDRS Part III. scores: 10.5 ± 19. vs. 30.5 ± 11.3, p = 0.040) than nonreversible parkinsonism. DaTSCAN images were normal in all trimetazidine-induced reversible parkinsonism patients, while these images were abnormal in every patient with nonreversible parkinsonism. In cases of nonreversible parkinsonism, preexisting, incipient Parkinson's disease was suspected by clinical appearance and a good response to antiparkinsonian medication. Mild and symmetrical appearance of parkinsonism with normal DaTSCAN results can indicate drug-induced parkinsonism. Trimetazidine discontinuation generally results in permanent remission in such cases.

Sections du résumé

BACKGROUND
Although trimetazidine may induce parkinsonian symptoms in some patients, no systematic characterization has been reported on parkinsonism occurring during trimetazidine treatment since the first case reports.
OBJECTIVE
To systematically investigate parkinsonism occurring during trimetazidine use.
METHODS
Thirty-three consecutive patients on trimetazidine treatment with previously unrecognized parkinsonian symptoms were enrolled. Detailed neurological and neuropsychological examinations were performed at baseline and 1 and 12 months after trimetazidine withdrawal. In cases with persisting parkinsonian symptoms and suspected de novo Parkinson's disease, antiparkinsonian treatment was initiated. Twenty of the 33 patients underwent DaTSCAN imaging.
RESULTS
After trimetazidine withdrawal, parkinsonism was completely resolved in 11 cases. The comparison of baseline data of patients with reversible and persisting parkinsonism showed that trimetazidine-induced reversible parkinsonism was mainly characterized by akinesia, rigidity, postural instability and gait disturbances (PIGD; PIGD scores: 5.3 ± 3.8 vs. 2.0 ± 1.6 points, p = 0.006) rather than tremors (tremor scores: 1.5 ± 2.2 vs. 7.7 ± 4.6 points, p = 0.000). Trimetazidine-induced reversible parkinsonism was also more symmetrical (asymmetry index: 3.1 ± 3.6 vs. 40.1 ± 22.2, p = 0.000) and milder in severity (MDS-UPDRS Part III. scores: 10.5 ± 19. vs. 30.5 ± 11.3, p = 0.040) than nonreversible parkinsonism. DaTSCAN images were normal in all trimetazidine-induced reversible parkinsonism patients, while these images were abnormal in every patient with nonreversible parkinsonism. In cases of nonreversible parkinsonism, preexisting, incipient Parkinson's disease was suspected by clinical appearance and a good response to antiparkinsonian medication.
CONCLUSIONS
Mild and symmetrical appearance of parkinsonism with normal DaTSCAN results can indicate drug-induced parkinsonism. Trimetazidine discontinuation generally results in permanent remission in such cases.

Identifiants

DOI: 10.1016/j.parkreldis.2019.01.005 PMID: 30638818
pubmed: 30638818
pii: S1353-8020(19)30005-7
doi: 10.1016/j.parkreldis.2019.01.005
pii:
doi:

Substances chimiques

Antiparkinson Agents 0
Trimetazidine N9A0A0R9S8

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

117-121

Informations de copyright

Copyright © 2019 Elsevier Ltd. All rights reserved.

Auteurs

Dávid Pintér (D)

Doctoral School of Clinical Neuroscience, Medical School, University of Pécs, Pécs, Hungary.

Márton Kovács (M)

Doctoral School of Clinical Neuroscience, Medical School, University of Pécs, Pécs, Hungary; Department of Neurology, Medical School, University of Pécs, Pécs, Hungary.

Márk Harmat (M)

Doctoral School of Clinical Neuroscience, Medical School, University of Pécs, Pécs, Hungary; Department of Neurology, Medical School, University of Pécs, Pécs, Hungary.

Annamária Juhász (A)

Doctoral School of Clinical Neuroscience, Medical School, University of Pécs, Pécs, Hungary; Department of Neurology, Medical School, University of Pécs, Pécs, Hungary.

József Janszky (J)

Department of Neurology, Medical School, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary.

Norbert Kovács (N)

Department of Neurology, Medical School, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary. Electronic address: kovacsnorbert06@gmail.com.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Trimetazidine and parkinsonism: A prospective study.
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Antidyskinésiques › Antiparkinsoniens › Trimetazidine and parkinsonism: A prospective study.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Trimetazidine and parkinsonism: A prospective study.
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Trimetazidine and parkinsonism: A prospective study.
questionsmedicales.fr › Maladies du système nerveux › Maladies neurodégénératives › Maladie de Parkinson › Trimetazidine and parkinsonism: A prospective study.
questionsmedicales.fr › Maladies du système nerveux › Maladies du système nerveux central › Troubles de la motricité › Syndromes parkinsoniens › Trimetazidine and parkinsonism: A prospective study.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Trimetazidine and parkinsonism: A prospective study.
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Dyskinésies › Tremblement › Trimetazidine and parkinsonism: A prospective study.
questionsmedicales.fr › Composés hétérocycliques › Composés hétéromonocycliques › Pipérazines › Trimétazidine › Trimetazidine and parkinsonism: A prospective study.