I have seen parkinsonism in a couple of patients on therapeutic doses of lithium (i.e. not toxic)... lithium is classically associated with a tremor that does not look very parkinsonian... someone I saw recently was on lithium, quetiapine and sodium valproate... all mood stabilisers and all (now) reported to cause parkinsonism... sometimes it can be very difficult to pick these cases apart and find the true cause of the symptoms...
Int Psychogeriatr. 2016 Aug 12:1-4. [Epub ahead of print]
Hermida AP, Janjua AU, Glass OM, Vaughan CP, Goldstein F, Trotti LM, Factor SA.
Lithium is a mood stabilizer rarely associated with drug-induced parkinsonism (DIP). We present a case of an elderly woman with bipolar disorder who developed parkinsonian symptoms after chronic lithium administration despite therapeutic serum levels. Upon evaluation, classic parkinsonian signs of muscle rigidity, tremor, bradykinesia, freezing of gait, and cognitive decline were observed. Initially, she was diagnosed with Parkinson's disease (PD); however, DaTscan SPECT imaging clarified the diagnosis as DIP. As the daily lithium dosage was reduced, the patient's motor symptoms improved. This report emphasizes close monitoring of lithium levels in geriatric populations and the need to consider lithium-induced parkinsonism when PD symptoms appear in chronic lithium users.
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