L-type calcium channel blockers and a symptom complex mimicking de Melo-Souza’s syndrome

  • Upinder Kaur
  • Pritam Das
  • Indrajeet Singh Gambhir
  • Sankha Shubhra ChakrabartiEmail author
Letter to the Editor

Dear Editor,

Drugs are an important cause of tremor in the elderly and the second most common cause of Parkinsonism. Common medications which induce tremor include salbutamol, theophylline, valproate, anti-depressants, anti-psychotics, and anti-dopaminergics [1, 2]. The T-type calcium channel blockers (CCBs), cinnarizine and flunarizine, are classically associated with a syndrome known as the “de Melo-Souza’s syndrome,” or flunarizine-cinnarizine-induced Parkinsonism (FCIP) [3, 4]. FCIP is diagnosed in a patient on these drugs, with any two of tremor, hypokinesia, rigidity, and postural instability. In its classic form, it mimics idiopathic Parkinson’s disease. The syndrome is often associated with depression and other features may include anxiety, insomnia, decreased facial expression, decreased deep tendon reflexes, and generalized weakness. Older females are the usual victims and the symptoms resolve following discontinuation of the concerned CCB [3, 4]. We present the case of an...


Funding support

Elderly Pharmacovigilance Programme has funding support from the National Programme for Healthcare of the Elderly, Ministry of Health and Family Welfare, Government of India.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Elderly Pharmacovigilance Programme has the institutional ethics committee approval no. Dean/2015-16/IEC/411.

Informed consent

Written informed consent was taken from patient’s legal guardian (son) for publication of case and videos.


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Copyright information

© Fondazione Società Italiana di Neurologia 2018

Authors and Affiliations

  1. 1.Department of Pharmacology, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
  2. 2.Department of General Medicine, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
  3. 3.Department of Geriatric Medicine, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia

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