Extrapyramidal parkinsonism in a 14 year-old boy developed 5 days after the accidental ingestion of a raw eggplant sprayed with the organophosphate dimethoate (Rogor), in a report from Meyer Children Hospital, Rappaport School of Medicine, Haifa, Israel. Symptoms began within 36 hours of the poisoning, with confusion, sweating, vomiting, and cardiac arrest. He was mechanically ventilated. Red blood cell cholinesterase was 2.5 units (normal range 11-18), and plasma cholinesterase 1.3 units (normal range 1.5-5). He was treated successfully with obidoxime hydrochloride (Toxogonin) and atropine. Within 4 days of poisoning he became withdrawn and agitated, and his movements were progressively slow, suggesting severe reactive depression, but one day later, marked rigidity, decreased facial expression, and a stooped, slowing gait with agitation established the diagnosis of parkinsonism. Neurologic examination showed a resting tremor, muffled voice, decreased blinking, and cogwheel rigidity. Treatment with amantidine, 100 mg 3 x daily, resulted in rapid clinical improvement within 48 hours and complete recovery after 1 week. Treatment was continued at a reduced dose for 3 months and then weaned with no recurrence of symptoms. A total of 26 similar cases reported in the literature, 1978 - 2004, are reviewed. [1]

COMMENT. Of the 27 cases of Parkinsonism with organophosphate insecticide poisoning reported, 21 (77%) recovered. Half recovered spontaneously and the remainder after treatment. Two died from respiratory failure, and 4 had persistent parkinsonism. Early diagnosis and treatment may prevent long-term basal ganglia dysfunction.