Objectives: Antipsychotics and antidepressants were well-known medications associated with an increased risk of secondary parkinsonism. Although the prescriptions of these medications are continuously increased in pediatric populations, there are no studies to investigate the prevalence of Parkinsonism and antipsychotics/antidepressants use in this population.

Methods: We conducted a case-crossover study to investigate the association between psychotropic medication use and Parkinsonism in Korean pediatrics under 19 years old using the Health Insurance Review and Assessment Service – Pediatric Patients Sample (HIRA-PPS), 10 % random sample of total pediatrics who visited the medical institution each year. In merged data of 7 years from 2010 to 2017, new parkinsonism cases included patients who had the first diagnosis record of Parkinsonism (G20 and G21 International Codes of Disease 10th Revision codes) from July to December in each year without diagnosis record of any movement disorders (ICD-10, G20–G26) before case incidence. Hazard period was defined as 1-30 days prior to the Parkinsonism event. We matched four control periods of 151-180 days, 121-150 days, 91-120 days, and 61-90 days prior to the incidence of the case. Conditional logistic regression was performed to estimate adjusted odds ratios (aORs) and 95% Confidence intervals (CIs).

Results: We identified 680 cases of Parkinsonism from 2010 to 2017; the number of cases increased from 12 cases in 2010 to 143 cases in 2017. More than half of the patients (451, 66.23%) were male, and most patients were 13–19 years old. The aOR of parkinsonism risk during the 30 days before the incidence of the event was 14.97 (95% CI 9.42–23.81) for antipsychotics and 5.31 (95% CI 3.39–8.31) for antidepressants, respectively.

Conclusion: The increase of parkinsonism observed and The use of antipsychotics and antidepressants was significantly associated with increased risk of Parkinsonism in pediatrics.