Ann Rehabil Med.  2013 Feb;37(1):147-150. 10.5535/arm.2013.37.1.147.

Drug Induced Parkinsonism Caused by the Concurrent Use of Donepezil and Risperidone in a Patient With Traumatic Brain Injuries

• Kang SH
• Kim DK

• KMID: 2266665
• DOI: http://doi.org/10.5535/arm.2013.37.1.147

Abstract

A 69-year-old male patient with previous history of traumatic brain injury 5 months ago was admitted to the Department of Neuropsychiatry because of aggressive behavior and delusional features. After starting on 2 mg of risperidone per day, his delusion, anxiety, and aggressive behavior gradually improved. Two weeks later, he was given 10 mg of donepezil per day for his mild cognitive impairment. After 6 weeks of admission in the Department of Neuropsychiatry, he showed parkinsonian features including difficulty in walking, decreased arm swing during walking, narrowed step width, scooped posture, bradykinesia, tremor, and sleep disorder. To rule out the primary Parkinsonism, dopamine transporter imaging technique [18F]fluoropropyl-carbomethoxy-iodopropyl-nor-beta-tropane positron emission tomography-computed tomography (18F]FP(IT PET-CT)) was performed, and dopamine transporter activity was not decreased. We considered that his parkinsonian features were associated with the combination of risperidone and donepezil. Both drugs were stopped and symptoms rapidly disappeared in several days.

Keyword

Parkinsonian disorders; Donepezil; Risperidone; Brain injuries

MeSH Terms

Anxiety
Arm
Brain Injuries
Delusions
Dopamine Plasma Membrane Transport Proteins
Electrons
Humans
Hypokinesia
Indans
Male
Mild Cognitive Impairment
Neuropsychiatry
Parkinson Disease
Parkinsonian Disorders
Piperidines
Posture
Risperidone
Tremor
Walking
Dopamine Plasma Membrane Transport Proteins
Indans
Piperidines
Risperidone

Figure

• 

  Fig. 1 Initial noncontrast computed tomography (CT) image after the traumatic brain injury. CT image shows subarachnoid hemorrhage on the right parietal lobe (A) and subdural hemorrhage on the left frontotemporal lobe (B).

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  Fig. 2 [18F]fluoropropyl-carbomethoxy-iodopropyl-nor-β-tropane brain positron emission tomography-computed tomography image. Normal dopamine transporter density in the bilateral putamen and bilateral caudate nucleus are observed.

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