The journal Annals of Pharmacotherapy highlights the first case report of reversible extrapyramidal symptoms (EPS) linked to zinc deficiency. In this report, a 66-year-old smoker with Parkinsonism and bipolar disorder was admitted to the hospital to treat a pleural effusion. Lab results revealed he had low serum vitamin C (0.3mg/dL) and zinc levels (44μg/dL); he was subsequently started on IV replacement for these micronutrients. In less than 24 hours following IV replacement, his movement disorder was undetectable.
While previous studies have demonstrated a link between vitamin C deficiency and Parkinsonism, this case highlights the potential role of zinc deficiency in the pathogenesis of movement disorders. Patients with severe psychiatric illness affecting food intake are particularly at risk for deficiency, such as the patient in this case (he reported an unintentional weight loss of 30 pounds over the past year). These patients are more likely to be malnourished, have a tendency to smoke, and may suffer from other chronic conditions such as diabetes, all of which put them at increased risk for vitamin C and zinc deficiency.
While there is no established regimen for treating micronutrient-related EPS, the authors suggest IV replacement that continues until symptoms resolve. Predisposing factors that contribute to the deficiency must all be addressed since recovery may not be sustained if the risk factors persist.
A 66-year-old man with Parkinsonism, pleural effusion, and bipolar disorder was found to have low serum vitamin C and zinc levels. Intravenous replacement of these micronutrients led to resolution of the movement disorder in less than 24 hours.
Parkinsonism has been associated with vitamin C deficiency, and recent cases of scurvy complicated by Parkinsonism have responded well to intravenous replacement of vitamin C. In this case, deficiency of zinc may have contributed to the development of a movement disorder. The likely pathophysiology of, and treatment recommendations for, Parkinsonism linked to deficiencies of vitamin C and zinc are reviewed.