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The answer is no. The Parkinson’s disease for which we know no cause and have no cure should really be termed Idiopathic Parkinson’s disease. This is what this information has been discussing up until now.

However, there is a group of much rarer diseases or syndromes, which cause the signs and symptoms of Parkinson’s disease along with other symptoms. Doctors tend to refer to the condition caused by this group of disorders as Parkinsonism rather than Parkinson’s disease. When the signs and symptoms of Parkinson’s disease are caused by drugs this is termed Drug-induced Parkinsonism. There are several causes of Parkinsonism, and we will look at some of these in a moment. It is important to understand the difference between Parkinsonism and Idiopathic Parkinson’s disease - or as we know it, Parkinson’s disease.

Drug-induced Parkinsonism
People who are receiving treatment for psychiatric disorders such as schizophrenia or severe depression are often prescribed drugs known as neuroleptics. Over a long period of time, these drugs interfere with the release of dopamine and so block the sending of messages within the brain. Other drugs called anti-emetics, which are used to prevent nausea, or vestibular sedatives, which are used to prevent dizziness, can also interfere with the release of dopamine and cause Parkinsonism.

Usually, if the drugs are stopped, the signs and symptoms of Parkinsonism disappear over the course of a few months, but sometimes it is not possible for the drug to be stopped without the original problem returning. In these cases, alternative drugs may be available, and you should always discuss the options with your doctor or specialist. The following table lists some of the common drugs that can cause Parkinsonism. There are others that only cause tremor as a side effect, with none of the other symptoms. If you are in any doubt, please ask your doctor, nurse or pharmacist.

Neuroleptic drugs
Chlorpromazine (Largactil)
Promazine (Sparine)
Trifluoperazine (Stelazine)
Thioridazine (Melleril)

Some other similar neuroleptic drugs
Flupenthixol (Depixol)
Haloperidol (Serenace)
Droperidol (Dropletan)

Anti-emetic drugs
Prochlorperazine (Stemetil)
Metochlopramide (Maxalon)

Vestibular sedatives
Cinnarizine (Stugeron)

These drugs should be avoided if you already have Parkinson’s disease.

Arterio-sclerotic Parkinsonism
Most of us know how a stroke can leave a person without the power of speech or the use of a limb. The same mechanism can cause damage to the specific area of the brain which degenerates in Parkinson’s disease, or to the pathways the chemical messengers use, or even to the areas where messages are received. This leads to Parkinsonism. On the whole, this type of Parkinsonism does not respond as well to drugs and tends to affect the legs rather than the arms. This is particularly frustrating since the affected person can sometimes sit and perform quite complex tasks such as knitting, but be unable to walk.

People with this type of Parkinsonism often have other vascular problems due to narrowing of the arteries. It is usually this that gives the doctor the clue that a person may be affected by Arterio-sclerotic Parkinsonism.

Post-encephalitic Parkinsonism
Between 1917 and 1926 a virus swept throughout the world, causing an epidemic of encephalitis. After the affected people recovered from the initial illness they went on to develop signs and symptoms of Parkinsonism, but with one unusual feature, which was an uncontrollable rolling up of the eyeballs. This variety of Parkinsonism is very rare. It can be treated in quite a similar way to Parkinson’s disease, but it does not respond well to treatment. The film Awakenings starring Robert De Niro and Robin Williams portrays this type of Parkinsonism very well.

Parkinsonism induced by poison
This is the type of Parkinsonism mentioned earlier, which was caused by drugs being made and then used by intravenous drug users in California in the mid-1980’s. They accidentally produced the toxin MPTP, and this caused the drug users to develop Parkinsonism almost overnight. This toxin is not found in our normal daily lives and therefore this type of Parkinsonism is rare. It responds well to standard drug treatment. Other poisons that can cause Parkinsonism include carbon monoxide, manganese and petroleum waste.

Progressive Supranuclear Palsy, Multiple System Atrophy and other akinetic-rigid syndromes
People who are affected by these types of Parkinsonism tend to be more stiff or slow in their movements than people who have Parkinson’s disease, but the signs and symptoms can be very similar. It is more common for people to develop emotional or memory problems early in the disease, and also speech or swallowing difficulties. Other signs that sometimes occur in these varieties of Parkinsonism include: problems with incontinence; severe balance problems; low blood pressure, leading to fainting; an inability to tolerate changes in temperature; restless sleep; noisy breathing or snoring; an inability to look down and a tendency to sigh.

People with these types of Parkinsonism may also develop involuntary jerking movements rather than tremor, and male patients may also become impotent. There are subtle differences in each of these types of Parkinsonism because they are caused by the degeneration of not only the substantia nigra as in Parkinson’s disease, but also of other clusters of cells and pathways in the brain as well. Not all the symptoms mentioned above develop in each of these types of Parkinsonism, and usually the diagnosis can only be made by a specialist. Other names which you may hear doctors use to describe these varieties of Parkinsonism are as follows:

• Striatonigral Degeneration
• MSA (Multiple System Atrophy)
• Olivopontocerebellar Atrophy
• Shy Drager Syndrome  
• PSP (Progressive Supranuclear Palsy)
• Steele Richardson Olszewski Syndrome
• Corticobasal Degeneration

The names refer to either the areas of the brain that are affected or to the people who first described the disorder. Medicines used for Parkinson’s disease do not tend to be particularly successful in treating these varieties of Parkinsonism.

What about head injury?
A single blow to the head is extremely unlikely to cause Parkinsonism, but repeated concussive injuries can. If you saw Mohammed Ali open the 1996 Olympic Games in Atlanta, you will know that he is affected by the disease. He may have Parkinson’s disease, or the hundreds of thousands of blows to the head he took in the ring over the years could have caused Parkinsonism by injuring the dopamine nerve cells.

Wilson’s disease
This is a metabolic disorder affecting the way the body excretes copper. Abnormal levels are stored by the body, and this causes damage to the brain, giving rise to Parkinsonism. The disease is usually seen in young adults rather than older people. Caught early it can be treated.

Structural problems
Usually the brain is continually bathed and cushioned by fluid called cerebrospinal fluid, or CSF. Sometimes the drainage system for this fluid can get blocked, resulting in an increase in pressure in the brain, which can give rise to Parkinsonism. The symptoms build up slowly and may be mistaken for Parkinson’s disease in the first instance. Memory problems and incontinence develop early. These, together with a specific way of walking, will lead the doctor to suspect the problem. Some of the symptoms can be relieved by an operation that diverts the fluid through a shunt. Drug treatment is not usually helpful. In exceptionally rare cases a brain tumour or other lesion can lead to Parkinsonism.