P175 – 2737: Effect of biperiden treatment in acute orofacial and extremity dyskinesia with methylphenidate theraphy

Abstract

Objective Methylphenidate is a short-acting stimulant drug commonly prescribed to individuals with attention deficit hyperactivity disorder. The suggested underlying mechanism of acute dyskinesias is dopaminergic transmission increase. This case report highlights the importance for physicians of awareness of dyskinesia as a potential side-effect of methylphenidate therapy and indicates benefit of biperiden theraphy. The parenteral form of biperiden is an effective and reliable agent for the treatment of acute episodes of extrapyramidal disturbances that may be seen during treatment with neuroleptic agents. Akathisia, akinesia, dyskinetic tremors, rigor, oculogyric crisis, spasmodic torticollis and profuse sweating are markedly reduced or eliminated. Methods We describe a 9-year-old male patient diagnosed with attention deficit hyperactivity disorder admitting to emergency clinic with primarily orofacial and extremity dyskinesia after the administration of a first dose of 18 mg methylphenidate. Methylphenidate was discontinued, and we injected biperiden with dosage of 0.04 mg/kg intravenously. Results The patient's symptoms resolved within 20 minutes after injection of biperiden (0.04 mg/kg). Conclusion We wish to emphasize that acute orofacial dyskinesia and extremity dyskinesia can be observed during methylphenidate therapy and that biperiden can be successfully used in the treatment of this unpleasant condition. So long as the mechanism involved in acute dyskinesia with methylphenidate therapy is based solely on hypothesis, however, the exact role of methylphenidate in preventing dyskinesia will remain unknown. To the best of our knowledge, this is the first report of the use of biperiden therapy in this condition.