Developmental Forms Of Parkinsonism

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Developmental forms of parkinsonism include syndromes induced by in utero or perinatal viral (or other) infection, such as maternal influenza during pregnancy or in utero or perinatal trauma or maternal stress. In utero influenza has been reported to be a cause of parkinsonism in a young child (85). Parkinsonism was reported in children born to mothers with encephalitis lethargica (85). Asphyxia during delivery, prenatal disturbances, premature birth, or early-childhood meningoen-cephalitis, often in combination with a complicated pregnancy, were all described to predispose to parkinsonian syndromes. The clinical symptoms included rigidity, hypokinesia, and in a small percentage, tremor. These children also had other neurological abnormalities including cognitive problems, behavioral difficulties, headaches, and strabismus. Treatment with levodopa was reported to be effective. Dyskinesia was noted to be a side effect 8-30 months after therapy, and by 3 years levodopa

Table 1

Secondary Causes of Parkinsonism

Vascular (includes parkinsonism and PSP): with vascular risk factors, hyperhomocystinemia, and CADASIL.

Toxin exposure: MPTP (1-methyl-4-phenyl-1,2,3,6- tetrahydropyridine), manganese, carbon monoxide, cyanide, ethanol, methanol, and other solvents.

Infectious: HIV (human immunodeficiency virus), SSPE (subacute sclerosing pan encephalitis), mycoplasma pneumoniae infection.

Metabolic: Hyperparathyroidism.

Post-anoxic

Drug-induced: Neuroleptic agents, dopamine depletors, amiodarone, calcium channel blockers.

Peripherally induced: parkinsonism owing to injury.

Reversible parkinsonism in childhood: Hypoxic ischemic injury, neuroleptics, cytosine arabinoside, cyclophosphamide, amphotericin B, methotrexate, encephalitis, pineal germinoma, neuroleptic malignant syndrome, stroke, head injury, hydrocephalus, kernicterus, and radiation necrosis.

Hemiatrophy-hemiparkinsonism

Structural lesions causing parkinsonism: Posterior fossa tumors, right temporal lobe hemorrhage, intrinsic brainstem tumors.

Other causes: Multiple sclerosis.

was withdrawn. This was a reversible syndrome with very slight progression, and was though to be a result of decreased metabolic activity. Overall, a minority of patients with pre- or perinatal infections or trauma present with parkinsonism with eventual resolution of symptoms and a favorable prognosis.

An important to recognize but poorly understood syndrome is that of cerebral palsy or static encephalopathy that later progresses and causes gradual neurological deterioration. In a study of delayed-onset progressive movement disorders after static brain lesions, about 15% had parkinsonism (86). The precipitating insults included perinatal hypoxic ischemia, stroke, head injury, encephalitis, CO, kernicterus, and radiation necrosis.

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