Acute Dystonic Reactions Research Articles

ECT for Catatonia in an Autistic Girl

ECT for Catatonia in an Autistic Girl

Neurologic Complications of Liver Transplantation in Pediatric Patients With the Hepatic Form of Wilson's Disease

The literature contains very little documentation on neurologic complications in liver transplant recipients for Wilson's disease. We retrospectively reviewed 17 consecutive cases of pediatric liver transplantation for the hepatic form of Wilson's disease to assess the types of neurologic complications that occurred, the incidence of those problems, and associated factors in this patient group. The patients were 12 boys and 5 girls; indications for liver transplantation were fulminant hepatic failure in 3 patients and chronic hepatic failure in 14 patients. Neurologic complications were observed in 10 of the 17 patients as 16 episodes. The most common neurologic complications were seizure (7 episodes in 6 patients) and sudden-onset headache (5 episodes in 4 patients). Tacrolimus was identified as the only possible cause of headache in 3 episodes. Encephalitis was the cause in 1 and intracranial hemorrhage was the cause in the other headache episode. We also noted 1 episode of tremor, 1 episode of acute dystonic reaction, 1 episode of diffuse encephalopathy, and 1 episode of common peroneal nerve palsy. Immunosuppressive agents were the primary cause of 12 of the 16 episodes of neurologic complications. Uremia with hypertension, compression of the right common peroneal nerve, encephalitis, and intracranial hemorrhages attributable to coagulopathy caused 1 neurologic episode each. Neurologic complications in patients with the hepatic form of Wilson's disease were frequent during the first 30 days after pediatric liver transplantation but did not affect survival. Transplantation teams should be aware of the high incidence of neurologic complications in pediatric patients with the hepatic form of Wilson's disease.

Acute Pisa Syndrome and Pharnygolaryngeal Dystonia Due to Ziprasidone

Back to table of contents Previous article Next article LETTERFull AccessAcute Pisa Syndrome and Pharnygolaryngeal Dystonia Due to ZiprasidoneHarpreet S. Duggal M.D., D.P.M.,Harpreet S. Duggal M.D., D.P.M.Search for more papers by this author,Published Online:1 Jan 2008AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Pisa syndrome (truncal dystonia with lateral flexion and slight rotation of the trunk) and pharyngolaryngeal dystonia are rare antipsychotic-induced dystonias. A patient developing these dystonic reactions while on ziprasidone is described. Case ReportMr. A, a 20-year-old Caucasian male, was admitted for exacerbation of schizoaffective disorder. He had comorbid cocaine dependence. On the day of admission (day 1), Mr. A was started on divalproex sodium, 500 mg/day, ziprasidone, 60 mg/day, and trazodone, 100 mg at bedtime. On day 2, the divalproex sodium was increased to 1000 mg/day while ziprasidone was increased to 60 mg b.i.d. with meals. Two hours after receiving the third dose of ziprasidone (before the bedtime doses of divalproex sodium and trazodone were administered), the patient developed lateral flexion of the trunk toward the right side with slight rotation. He also developed dysphonia and dysphagia. His pulse and blood pressure were 102/minute and 120/74 mmHg, respectively, and no other extrapyramidal symptoms were evident. Mr. A received benztropine, 1 mg i.m., resulting in rapid and complete resolution of the symptoms. The patient was subsequently started on oral benztropine, 1 mg b.i.d., while ziprasidone was continued at 60 mg b.i.d. along with divalproex sodium (1000 mg/day; serum level: 58 mg/ml) and trazodone (100 mg/day). There was no recurrence of dystonia on a follow-up one month later as an outpatient.Discussion There is only one report of Pisa syndrome with ziprasidone in the literature 1 and a PubMed search did not reveal any association of ziprasidone or other second-generation antipsychotics with pharyngolaryngeal dystonia. A similar search did not reveal any association of trazodone with Pisa syndrome and pharyngolaryngeal dystonia. Incidentally, a single case of Pisa syndrome in a patient taking valproic acid is described, but the authors were not certain whether this was due to valproic acid alone or due to a combination of valproic acid and risperidone. 2 The temporal correlation of the appearance of acute dystonia after increasing the dose of ziprasidone implicates this drug, as substantiated by other reports of acute dystonia with this drug. 3 , 4 Of interest, cocaine use has been postulated as a risk factor for acute antipsychotic-induced dystonia and this along with the young age, male gender, and rapid escalation of antipsychotic dose may have been the risk factors pertinent to this case. 5 This report underscores that pharyngolaryngeal dystonia, which has only been described with the first-generation antipsychotics, can also occur with the second-generation antipsychotics. Greater awareness of this adverse effect is desirable as the use of these drugs increases. Herrick Medical Center, Tecumseh, MichiganReferences1 . Ziegenbein M, Schomerus G, Kropp S: Ziprasidone-induced Pisa syndrome after clozapine treatment (letter). J Neuropsychiatry Clin Neurosci 2003; 15:458–459Google Scholar2 . Yohanan M, Aulakh JS, Weith J, et al: Pisa syndrome in a patient in a wheelchair taking valproic acid (letter). Am J Psychiatry 2006; 163:325–326Google Scholar3 . Mason MN, Johnson CE, Piasecki M: Ziprasidone-induced acute dystonia (letter). Am J Psychiatry 2005; 162:625–626Google Scholar4 . Weinstein SK, Adler CM, Strakowski SM: Ziprasidone-induced acute dystonic reactions in patients with bipolar disorder (letter). J Clin Psychiatry 2006; 67:327–328Google Scholar5 . van Harten PN, Hoek HW, Kahn RS: Acute dystonia induced by drug treatment. Br Med J 1999; 319:623–626Google Scholar FiguresReferencesCited byDetailsCited ByValproate-associated Movement Disorder: A Literature Review3 October 2021 | Prague Medical Report, Vol. 122, No. 3ZiprasidoneThe Lancet Neurology, Vol. 15, No. 10Acute dystoniaPisa Syndrome After Discontinuation of Clotiapine in a Patient With Intractable InsomniaJournal of Clinical Psychopharmacology, Vol. 34, No. 2 Volume 20Issue 1 Winter, 2008Pages 108-109 Metrics PDF download History Published online 1 January 2008 Published in print 1 January 2008

Acute Dystonic Reaction in an Adolescent on Risperidone When a Concomitant Stimulant Medication is Discontinued

This report describes an acute dystonic reaction that occurred after dexamphetamine was discontinued from a drug regimen that included risperidone. This is the second report that has revealed a possible rebound dystonia when a stimulant medication is withdrawn from a patient taking risperidone. We also discuss the neurophysiological hypotheses and implications for treatment.

Ziprasidone in Adolescents with Autism: An Open-Label Pilot Study

The antipsychotic drugs are the best-studied agents shown to reduce symptoms in autism, including hyperactivity, aggression, self-abusive behavior, temper tantrums, lability, irritability, social withdrawal, and stereotypical behaviors. However, significant weight gain has been associated with use of many atypical agents. Ziprasidone has been weight neutral in adult populations, but data from adolescents and patients with autism are sparse. However, ziprasidone administration has been associated with increases in the QTc. The purpose of this study was to collect pilot data on the efficacy and safety of ziprasidone in adolescents with autism, focusing on safety issues of weight gain and QTc. Twelve adolescents with autism (mean age 14.5 +/- 1.8 years) were treated in a 6-week open pilot study. Ziprasidone dosage ranged from 20 to 160 mg/day (mean, 98.3 +/- 40.4 mg/day). The primary efficacy measure was the Clinical Global Impressions-Improvement item (CGI-I); other efficacy measures included the Aberrant Behavior Checklist and the Children's Psychiatric Rating Scale. Based on the CGI-I, 9 of 12 (75%) patients were treatment responders. Ziprasidone was weight neutral, and the QTc increased by a mean of 14.7 msec. Two subjects had acute dystonic reactions. Cholesterol decreased and prolactin remained the same. Ziprasidone shows promise as a treatment for adolescents with autism. More definitive trials are needed.

MDP012 Cetirizine-induced acute dystonic reaction in a child

MDP012 Cetirizine-induced acute dystonic reaction in a child

Acute dystonic reaction secondary to prochlorperazine use in the treatment of hyperemesis gravidarum

Acute dystonic reaction secondary to prochlorperazine use in the treatment of hyperemesis gravidarum

Primary craniocervical dystonia presenting as a respiratory emergency

The craniocervical region is frequently affected by dystonia. Facial, lingual, masticatory, and laryngeal muscle involvement is reported in >75% of cases with primary focal/segmental dystonia.1 Symptoms in these cases appear gradually, and there is sufficient time for the patients to seek proper medical attention. Acute dystonic reactions are often secondary to dopaminergic receptor antagonism. Acute laryngeal dystonia has been identified as a life-threatening side effect of classic antipsychotics.2 Herein we describe a patient with primary craniocervical dystonia who presented as a respiratory emergency. A previously healthy 52-year-old man was diagnosed with possible mild asthma after mild breathing difficulties of subacute onset. Following this diagnosis, he was prescribed standard antiasthmatic medication with no success and was scheduled for a detailed workup. About 2 months later, while at rest, he suddenly developed extreme difficulty breathing and was rushed to the emergency department where a tracheostomy was performed due to upper airway obstruction. There was no definite …

High-dose ziprasidone-induced acute dystonia

There are few clinical data describing the relative risks of extrapyramidal symptoms (EPS) at higher doses of ziprasidone (i.e., greater than 160 mg/day) when compared to lower doses. We report on a patient who displayed no EPS with ziprasidone 160 mg/day for several months, but did display marked, acute dystonic reactions on ziprasidone 240 mg/day. The observations from the present case indicate that high-dose, ziprasidone-induced acute dystonia may occur even if no such side effects have been experienced at doses up to and including 160 mg/day.

Neurological complications of liver transplantation in pediatric patients: A single center experience

Neurologic complications (NCs) are a significant cause of morbidity and mortality in patients who undergo liver transplantation (LT). The aim of this study was to evaluate the incidence and type of NCs and associated factors in pediatric LT patients. We retrospectively reviewed NCs in the medical records of 40 consecutive infants, children, and adolescents who underwent LT at our institution. The subjects consisted of 23 boys and 17 girls (median age, 8.5 +/- 0.85 yr; range, 11 months to 17 yr). The indications for LT were Wilson's disease in 10 patients, fulminant hepatic failure (FHF) in nine, and other types of chronic liver disease in 21. NCs were found in 14 patients (35%). Those 14 individuals experienced a total of 16 episodes of NCs (two separate episodes in two of the patients). The most common NCs were seizure (seven episodes in six patients) and posterior leukoencephalopathy syndrome (PLES; five episodes in four patients). Seizure was the presenting symptom in three episodes of PLES. Two episodes of diffuse encephalopathy were observed in two patients, and two episodes of psychiatric symptoms occurred in two patients. We also noted one episode of tremor in one patient, one episode of acute dystonic reaction in one patient, and one episode of headache in one patient. Patients with Wilson's disease had a higher incidence of NCs (60%) than did patients without Wilson's disease (26.7%); however, this difference was not significant. The incidence of NCs was 44% in patients with FHF and 35% in those without FHF. That difference also was not significant. Immunosuppressive agents were the primary cause of 13 of the 16 episodes of NC. Uremia with hypertension, hypoxia, and hypomagnesemia caused one neurologic episode each. NCs, which are frequent in the first 30 days after pediatric LT, did not affect survival in this group. NCs were reversed by the discontinuation or reduction of immunosuppressive agents in 12 episodes, correction of hypomagnesemia and the reduction of immunosuppressive agents in one episode, and the correction of uremia and hypertension in one episode. Refractory epilepsy developed in one patient, and death unrelated to NCs occurred in one. The mortality rate was 7.1% (n = 1) in patients with NCs and 15.4% (n = 4) in those without NCs (p = 0.64). NCs are an important complication after LT. It is essential that each transplantation team collaborate with pediatric neurologists to ensure the rapid and accurate diagnosis of NCs in infants, children, and adolescents after LT and to prevent the delay of appropriate treatment.

ADRs in a Community Hospital – Do These Numbers Look like Yours?; A Gaggle of “Dermatologic” Reactions – TEN, Iodide Mumps, Doxycycline Phototoxicity; Pergolide-Induced Ergotism; Acute Coronary Syndrome Due to Fluorouracil Infusion; Aripiprazole-Induced Acute Dystonic Reaction; Meta-Analysis: Cardiovascular Events and NSAIDs; More on Dopamine Agonists and Impulse Control Disorders

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.

Antiemetic-related dystonic reaction unmasked by removal of a scopolamine transdermal patch

A case of a dystonic reaction is presented that occurred after the use of prochlorperazine, metoclopramide and ondansetron for the treatment of post-operative nausea and vomiting. The onset of dystonia coincided temporally with the removal of a transdermal scopolamine patch used as adjunctive antiemetic therapy. Withdrawal of concurrently administered anticholinergic medication, after recent use of antiemetic medications with dopamine receptor (D 2) inhibition, can unmask a dystonic reaction. This case also suggests that transdermal scopolamine may offer an innovative therapy for the treatment of acute dystonic reactions.

Ziprasidone-Induced Acute Dystonic Reactions in Patients With Bipolar Disorder

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.Sir: We have recently observed 2 cases of acute dystonic reactions in ziprasidone-treated patients with bipolar disorder. Although characterized by relatively high dopamine-2 (D2) binding, ziprasidone has been associated with a low rate of extrapyramidal symptoms and dystonia.1,2 Of 4 early clinical trials with ziprasidone,3-6 only 1 trial, in patients with schizophrenia and schizoaffective disorder, has reported any dystonia.3

Paediatric psychopharmacology in schizophrenia

Schizophrenia in children and adolescents is a devastating condition requiring urgent and aggressive treatment. However, the evidence base for the efficacy and safety of antipsychotic drugs is limited in this age group. Children and adolescents are particularly sensitive to developing severe, acute dystonic reactions with high potency typical antipsychotics such as haloperidol. Atypical antipsychotics; risperidone, olanzapine and quetiapine have equivalent efficacy but produce fewer extrapyramidal side effects and should be used as first-line drugs in the treatment of schizophrenia. Clozapine has superior efficacy against positive and negative symptoms but is reserved for treatment resistant cases. Children and adolescents appear more sensitive than adults to weight gain and metabolic changes (increased glucose and lipids) that is particularly associated with clozapine and olanzapine. Risperidone may produce extrapyramidal symptoms at higher doses (>4 mg/day) and hyperprolactinaemia. In children, antispychotics should be started at low doses and titrated slowly upwards. Baseline and follow-up monitoring of symptoms and adverse effects is essential. The sensitivity of young patients to adverse effects of antipsychotics should be anticipated and actively managed from the start of treatment as it has significant impact on treatment adherence and physical health.

Diagnosis and management of acute movement disorders

Most movement disorders, reflecting degenerative disorders, develop in a slowly progressive fashion. Some movement disorders, however, manifest with an acute onset. We wish to give an overview of the management and therapy of those acute-onset movement disorders.Drug-induced movement disorders are mainly caused by dopamine-receptor blockers (DRB) as used as antipsychotics (neuroleptics) and antiemetics. Acute dystonic reactions usually occur within the first four days of treatment. Typically, cranial pharyngeal and cervical muscles are affected. Anticholinergics produce a prompt relief. Akathisia is characterized by an often exceedingly bothersome feeling of restlessness and the inability to remain still. It is a common side effect of DRB and occurs within few days after their initiation. It subsides when DRB are ceased. Neuroleptic Malignant Syndrome is a rare, but life-threatening adverse reaction to DRB which may occur at any time during DRB application. It is characterised by hyperthermia, rigidity, reduced consciousness and autonomic failure. Therapeutically immediate DRB withdrawal is crucial. Additional dantrolene or bromocriptine application together with symptomatic treatment may be necessary. Paroxysmal dyskinesias are childhood onset disorders characterised by dystonic postures, chorea, athetosis and ballism occurring at irregular intervals. In Paroxysmal Kinesigenic Dyskinesia they are triggered by rapid movements, startle reactions or hyperventilation. They last up to 5 minutes, occur up to 100 times per day and are highly sensitive to anticonvulsants. In Paroxysmal Non-Kinesiogenic Dyskinesia they cannot be triggered, occur less frequently and last longer. Other paroxysmal dyskinesias include hypnogenic paroxysmal dyskinesias, paroxysmal exertional dyskinesia, infantile paroxysmal dystonias, Sandifer's syndrome and symptomatic paroxysmal dyskinesias. In Hereditary Episodic Ataxia Type 1 attacks of ataxia last for up to two minutes, may be accompanied by dysarthria and dystonia and usually respond to phenytoin. In Type 2 they can last for several hours, may be accompanied by vertigo, headache and malaise and usually respond to acetazolamide. Symptomatic episodic ataxias can occur in a number of metabolic disorders, but also in multiple sclerosis and Behcet's disease.

Acute Dystonia Induced by Lamivudine

Lamivudine is the most widely prescribed drug of choice for chronic hepatitis B infection, which is a common health problem in China. Generally, the administration of lamivudine has been well tolerated. The authors report two cases of acute dystonic reactions (ADRs) as a side effect of lamivudine. ADR induced by drug treatment can be a side effect of treatment with antipsychotic drugs and other drugs; however, there have been no reports of lamivudine-induced ADR in the English literature. The authors think that although lamivudine is widely used and well tolerated, it can cause ADRs, which are reversible after drug withdrawal.

Acute Dystonic Reaction and the Neuroleptic Malignant Syndrome

Up to 90% of patients on chronic antipsychotic therapy will experience adverse neurologic side effects, with many of these effects attributable to the dopamine-blocking properties of these drugs. Even the newer, “atypical” antipsychotics are increasingly associated with neurologic complications. In the acute care setting, these medications have broad application beyond the management of psychiatric illness. Given the extent of their use, clinicians should be familiar with the spectrum of neurological syndromes that can develop. Some are common, such as akathisia, acute dystonic reaction, tardive dyskinesia, and drug-induced parkinsonism. Others, such as the life-threatening neuroleptic malignant syndrome, are rare yet must be recognized early to affect survival and improve outcome. This discussion highlights 2 idiosyncratic syndromes, acute dystonic reaction and neuroleptic malignant syndrome. The differential diagnosis for both syndromes and their management is discussed.

Metoclopramide induced dystonia in children: two case reports

Metoclopramide is a dopamine antagonist that is widely used in gastroesophageal disease and chemotherapy-induced emesis in the paediatric population. It is also prescribed in nausea and vomiting caused by respiratory tract infections and enteritis in practice. The primary side-effect of the drug is extrapyramidal reactions with incidences as high as 25% in children. We report two cases, one of which was referred to our emergency department as encephalitis and the other as tetany, but which were just acute dystonic reactions caused by metaclopramide, even though the patients had used the drug in the recommended dosages. The adverse effects of the drug can be seen at normal doses. These dystonic reactions caused by metaclopramide can easily be confused with other diseases, because dystonia is not seen frequently in paediatric practice whatever the cause.

High vulnerability to acute dystonic reactions: A case of antipsychotic exposure and uncontrolled seizure activity

Antipsychotic-induced extrapyramidal side effects have a negative impact on treatment for mental illness. Acute dystonic reactions are uncomfortable and frightening to the patient, and often lead to early discontinuation of drug therapy and worsened long-term outcome. The lower propensity of the atypical antipsychotic agents to cause extrapyramidal symptoms (EPS) has been associated with multiple benefits, including improved adherence. The authors describe a 57-year-old male patient who was in the treatment refractory unit. This patient exhibited extreme sensitivity to antipsychotic agents, experiencing acute dystonic reactions with quetiapine and olanzapine, in addition to older typical antipsychotic agents. The patient has not experienced acute EPS since therapy with aripiprazole was initiated. Further complicating this patient's course is his unusual sensitivity to experiencing dystonic reactions. We have observed acute dystonias in the absence of antipsychotic treatment and in the context of seizure activity (or paroxysmal dyskinetic activity). The true etiology of the latter dystonic activity has not been completely determined due to the patient's unwillingness to cooperate with invasive testing. None of the gene variations tested (CYP2D6 phenotype, two dopamine D2 receptor variants and one D3 receptor variant) appeared to explain the patient's vulnerability to acute dystonic reactions.

Patient Management Exercise For Delirium

Patient Management Exercise F<scp>or</scp> D<scp>elirium</scp>