Section - Video Lectures

06. Extrapyramidal Symptoms: Management Strategies

Published on December 2, 2025 Certification expiration date: December 2, 2028

Gregory Pontone, M.D., M.H.S.

Division Chief of Aging, Behavioral, and Cognitive Neurology - University of Florida College of Medicine

Key Points

Drug-induced parkinsonism is bilateral and symmetrical, featuring postural tremor. In contrast, idiopathic Parkinson’s disease starts unilaterally with a rest tremor.
New biomarkers, such as the dopamine transporter SPECT scan (DaT Scan), may help differentiate drug-induced parkinsonism from idiopathic Parkinson’s disease (which shows an abnormal scan).
To address EPS-related dysfunction, consider lowering the dose, switching to a different medication, or using anticholinergics. If those fail, try amantadine as an alternative.

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Slides and Transcript

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Section 6: Clinical Pointers on Managing Extrapyramidal Symptoms.

Extrapyramidal Symptoms: Management Strategies Slide 1 of 14

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So one of the first distinctions you’ll have to make especially if you’re working with elderly patients is whether you have a drug-induced parkinsonism or an idiopathic Parkinson’s disease. So, I want to give you a few comparisons and it’s important not to be dogmatic about these but to use the clustering of these differences to help you make a decision. Typically, in drug-induced parkinsonism, the symptoms will be bilateral and symmetrical. Oftentimes, idiopathic Parkinson’s disease is a unilateral disease for like many years before it becomes a bilateral disease.

References:

Jeong, S., Cho, H., Kim, Y. J., Ma, H. I., & Jang, S. (2021). Drug-induced Parkinsonism: A strong predictor of idiopathic Parkinson's disease. PLoS One, 16(3), e0247354. https://doi.org/10.1371/journal.pone.0247354
Brigo, F., Erro, R., Marangi, A., Bhatia, K., & Tinazzi, M. (2014). Differentiating drug-induced parkinsonism from Parkinson's disease: An update on non-motor symptoms and investigations. Parkinsonism & Related Disorders, 20(8), 808-814. https://doi.org/10.1016/j.parkreldis.2014.05.011

Extrapyramidal Symptoms: Management Strategies Slide 2 of 14

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07. Tardive Dyskinesia: Clinical Features, Epidemiology, and Mechanisms

Learning Objectives:
After completing this activity, the learner will be able to:

Identify and differentiate between the four main types of drug-induced movement disorders (akathisia, extrapyramidal symptoms, tardive dyskinesia, and acute dystonia) and select appropriate evidence-based treatments for each.
Assess patients for medication-induced cognitive impairment and implement strategies to minimize cognitive side effects while maintaining therapeutic efficacy.
Apply a systematic approach to evaluate and manage extrapyramidal symptoms, including distinguishing drug-induced parkinsonism from idiopathic Parkinson’s disease using clinical features and biomarkers when appropriate.

Original Release Date: December 02, 2025
Expiration Date: December 02, 2028

Faculty: Gregory Pontone, M.D., M.H.S.
Medical Editor: Tomás Abudarham, M.D.

Relevant Financial Disclosures:
Gregory Pontone declares the following interests:
– Acadia Pharmaceuticals Inc: Consultant
– GE Healthcare: Consultant

All the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

None of the other faculty, planners, and reviewers for this educational activity has relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement
Medical Academy designates this enduring activity for a maximum of 1.25 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.