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Extractions: Parkinsonism PD is generally accepted as a clinicopathological entity that is different from other causes of extrapyramidal signs. However, since there is no accurate biological marker for PD, the differential diagnosis of parkinsonism can be extremely arduous. The reported proportion of cases of parkinsonism induced by drugs varies from 8 to 51%. The relative frequency of drug-induced parkinsonism may be underestimated since drug reactions in older persons may suggest the presence of a new disease or may simply be attributed to the aging process. This misinterpretation is particularly likely when the drug-induced symptoms correlate almost perfectly with those of PD, an illness that occurs more frequently in the elderly. In addition, a global underestimation of adverse drug effects in the elderly is likely, since this group is underrepresented in premarketing clinical trials. The proportion of drug-induced parkinsonism may on the other hand be overestimated if some patients had previous subclinical idiopathic PD, and the onset of the classical symptoms coincided with the use of the incriminated drug. Either underestimation or overestimation can also occur depending on the selection of study patients and the criteria used to establish the putative causal relationship.
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