We present a 1 7-year-old female with acute extra-pyramidal
parkinsonism complicating a suicidal attempt with the
organophosphate insecticide chlorpyrifos, who was initially suspected to have developed severe depression or
psychosis. On admission she was stupurous, with diarrhoea and massive salivation lapsing into
respiratory failure and
coma. Following
atropine and
toxogonin treatment along with
mechanical ventilation she developed overt extrapyramidal
parkinsonism and
encephalopathy, characterized by impaired sensorium and agitation, mask
facies along with a muffled voice and swallowing impairment, a
resting tremor with
cogwheel rigidity switching to bradykinetic choreoathetotic movements. Once a
parkinsonian syndrome was diagnosed, she was given
amantadine therapy with complete recovery. The patient is presently maintained on
amantadine therapy; there was mild worsening of her extrapyramidal signs following unplanned discontinuation of this medication, and on follow-up assessments after 9 months she is virtually asymptomatic. A parkinsonian extrapyramidal syndrome, complicating
organophosphate intoxication, should therefore also be taken into account in any patient with
organophosphate poisoning, presenting with marked behavioural alterations, rigidity or
akinetic mutism, and beneficial response to
amantadine.