Journal of Advanced Clinical Neurology Research

Abstract

Drug-induced parkinsonism (DIP) refers to parkinsonian symptoms that emerge after initiating or adjusting certain medications. Although DIP has been frequently associated with selective serotonin reuptake inhib itors, cases related to serotonin–norepinephrine reuptake inhibitors are uncommon, especially those with progressive features. We describe a 52-year-old woman with major depressive disorder, fibromyalgia, and rheumatoid arthritis who developed orofacial and limb tremors one month after starting duloxetine (30 mg/ day). Her symptoms continued to worsen—spreading to the distal limbs and accompanied by dysphagia and speech difficulties—even after the medication was discontinued. Brain perfusion scintigraphy showed no interval change in her preexisting bilateral prefrontal hypoperfusion and preserved dopamine transporter binding in the striata and basal ganglia. These imaging findings supported a diagnosis of DIP rather than primary neurodegenerative parkinsonism, highlighting duloxetine’s potential to trigger persistent, progressive parkinsonism and the value of brain scintigraphy in evaluating suspected DIP.