Various agents (e.g., prescription drugs, OTC-medications, agricultural chemicals) have a potential to cause neurological disorders including cognitive impairment, movement disorders, convulsions and peripheral neuropathy. Among them, extrapyramidal motor disorders (e.g., parkinsonian symptoms and tremor) are often caused by drugs acting on central nervous system, deteriorating quality of life in many patients. Recent progress in pharmacology/drug safety research revealed detailed mechanisms for the pathogenesis and treatment of drug-induced extrapyramidal side effects (EPS). Although the dopaminergic system dysfunction has long been considered to be the primary cause of parkinsonian symptoms, it is now known that multiple serotonergic (5-HT1A, 5-HT2A, 5-HT3 and 5-HT6 receptors), adrenergic (α2A and α2C receptors) or cholinergic (muscarinic) receptors play crucial roles in modulating the EPS induction. In this presentation, we introduce the mechanisms underlying the pathogenesis and treatment of EPS, with a focus on drug-induced parkinsonian symptoms and tremor, and discuss the prediction and management of EPS at clinical settings (e.g., treatment of schizophrenia, mood disorders, Alzheimer's disease) and chemical intoxication.

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