Antipsychotic induced chronic recurrent oculogyric crisis in a patient with obsessive compulsive disorder.

Abstract

Dystonia is characterised by sustained muscle contractions leading to twisting or repetitive movements or abnormal postures. It can affect any body area including the neck (retrocollis, antecollis, torticollis or laterocollis), eyelids (blepharospasm), face (oromandibular dystonia), larynx (laryngeal dystonia), limbs (leg dystonia, arm dystonia) and trunk (truncal dystonia). It may be hereditary or secondary to factors like infection, poisoning or reaction to antipsychotics (Singh et al. 2012). Tardive dystonia (TD) is one of the uncommon extrapyramidal side effects associated with long-term use of dopamine receptor antagonists affecting around 3 % of individuals exposed to these medications (Van Harten and Kahn 1999). It often remains undiagnosed or misdiagnosed (Burke et al. 1982). Tardive dystonia is worsened with physical exertion or fatigue and improved with sleep or relaxation. Sometimes, transient improvement in severity or subjective distress may occur by applying ‘sensory tricks’ which are tactile or proprioceptive stimuli to the affected muscle(s) (Van Harten and Kahn 1999). Tardive oculogyric crisis is a type of TD which has been widely reported in literature (Bavle and Kumar 2013; Burke et al. 1982; FitzGerald and Jankovic 1989; Lim et al. 2008; Mendhekar et al. 2010; Praharaj et al. 2009; Sachdev 1993; Uzun and Doruk 2007). Tardive oculogyric crisis leads to episodic upward deviation of eyeballs causing severe distress to patients and hampering their normal day to day functioning. While tardive type oculogyric crisis has been repeatedly reported, the literature on acute onset chronic recurrent type oculogyric crisis is limited to a single case series (Sachdev 1993). We discuss a case of acute onset chronic recurrent type oculogyric crisis.