INTRODUCTION: : On Guadeloupe, atypical parkinsonism is abnormally frequent, and 
represents 75% of progressive parkinsonism while Parkinson's disease (PD) 
accounts for only 25%, which is an inversed percentage in comparison with 
Europe. Herbal tea made with Annonaceae leaves (containing 
benzyltetrahydroisoquinolines (Be-TIQ), tetrahydroprotoberberines (THPB) and 
acetogenins (potent mitochondrial complex I inhibitors) are commonly used on 
Guadeloupe.
CLINICAL STUDY: : Of 265 patients studied on Guadeloupe, 66 (25%) had PD, and 
199 (75%) had atypical parkinsonism. This latter group includes 58 patients 
(29%) with progressive supranuclear palsy (PSP), and 100 patients (50%) with 
unclassifiable parkinsonism (UP). This focus resembles the parkinsonism-dementia 
complex (PDC) described on Guam, where a very high prevalence of atypical 
parkinsonism has been reported since the second World War, including one-third 
of PSP. A preliminary case-control study on Guadeloupe showed a significant 
higher consumption of fruits and herbal tea of Annonaceae in atypical 
parkinsonian cases (PSP and unclassifiable parkinsonism, UP), compared to 
hospital controls and to idiopathic PD.
DISCUSSION: : The overrepresentation of atypical parkinsonism on Guadeloupe and 
Guam could be related to the consumption of plants containing (simultaneously) 
isoquinoline derivates which are toxic for dopaminergic neurons and inhibitors 
of the mitochondrial respiratory chain such as acetogenins. This hypothesis is 
in keeping with epidemiologic data and experimental studies showing neuronal 
loss after exposure to isoquinolines or acetogenins.