Metoclopramide-induced acute dystonic reaction misinterpreted as conversion disorder and seizure

Betul Akbuga-Ozel,Gökhan Aksel,Betul Gulalp,Elif Kilicli,Murat Muratoglu,Cemil Kavalci,Afsin Emre Kayipmaz

doi:10.29333/ejgm/81746

Abstract

Metoclopramide, an antiemetic, is the most common cause of drug-induced dystonic reactions. 20-year-old female patient, complaining of involuntary bilateral upward medial deviation of the eyes, generalized muscle contractions and uncontrollable cry was brought into the emergency department(ED) by an ambulance. The diagnosis of the ambulance crew was conversion or seizure. The patient has all of dystonic reaction symptoms, including facial, neck, back, and extremity spasms, opisthotonus, oculogyric crisis, torticollis, trismus. The history revealed 40 mg of metoclopramide intake. Biperiden (5 mg) was infused in 100 ml saline. Symptoms were completely resolved. She was discharged from the ED. Drug-induced dystonic reactions can be confused with conversion, seizures, encephalitis, tetanus and hypocalcemic tetany. It is important for emergency physicians to know the drugs that may have dystonic reaction as potential side effects, recognize the clinical presentation of drug-induced dystonic reactions, and properly manage them in the ED.

Highlights

Metoclopramide is a dopamine-2 antagonist and is commonly used for symptomatic treatment of gastrointestinal conditions
We present a case in which a 20-year-old female patient who suffered metoclopramide induced Acute dystonic reactions (ADR) was brought into the emergency department with involuntary bilateral upward medial deviation of the eyes, generalized muscle contractions and uncontrollable cry was brought into the emergency department by an ambulance crew and was misdiagnosed as having conversion disorder and epileptic seizure
Acute dystonic reactions present with contractions in the face and neck, involuntary extremity movements, opisthotonus, torticollis, oculogyric crisis, bulbar type speech, trismus, protruding tongue and seldom stridor and dyspnea caused by laryngospasm [4,5]

Summary

INTRODUCTION

Metoclopramide is a dopamine-2 antagonist and is commonly used for symptomatic treatment of gastrointestinal conditions. Patient was found to be fully alert and cooperative with Glasgow Coma Scale of 15 Her pupils were equal and reactive to light bilaterally. The patient’s history revealed that she had had diarrhea and vomiting for two days prior to ED presentation and she was taking 10 mg metoclopramide, PO twice daily, prescribed by her family physician. Her present complaints started abruptly after taking the fourth metoclopramide tablet, 30 minutes prior to the ED arrival. The patient denied loss of consciousness and head injury Her family history and history of medical conditions were negative. Her symptoms were completely resolved following the infusion and she was discharged from the ED free of symptoms and complaints

DISCUSSION

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CONCLUSION