Dystonias, drug-induced

As already noted in regard to dystonia, drug-induced neurological abnormalities are often subject to some degree of self-control. They can sometimes be partially relieved by sedatives and may worsen in reaction to emotional stress. Sachdev and Kruk (1994) found that the movements in most patients would lessen when they were distracted by something. 

Q Impaired Verbal Communication related to drug-induced extrapyramidal effects (eg, dystonia)... 

Thalamotomy and thalamic DBS, while effective against parkinsonian tremor, have been largely abandoned since they do not treat akinesia or bradykinesia. Interventions at the level of the STN or GPi are effective against akinesia, bradykinesia rigidity, tremor, as well as disabling drug-induced dyskinesias and dystonia. 

These alkaloids contain pyrrole or modified pyrrole, e.g. pyrrolidine, ring system. The simplest example of this class is nicotine. A pyrrolidine ring is the central structure of the amino acids proline and hydroxyproline. These alkaloids are also found in many drug preparations, e.g. procyclidine hydrochloride, which is an antichohnergic drug mainly used for the treatment of drug-induced Parkinsonism, akathisia and acute dystonia. 

This chapter will describe some of the most common, reversible, drug-induced neurological reactions acute dystonia acute akathisia parkinsonism and a broad, ill-defined category called dysphoria. All of them tend to begin early in treatment but can start later on as well. Chapters 4 and 5 will review the sometimes delayed and often persistent adverse reactions, including irreversible forms of akathisia and dystonia. 

Tardive dystonia can make an individual appear unsympathetic or bizarre, especially to the uninformed observer, who equates the facial grimaces or neck distortions with being crazy. As in all the drug-induced dyskinesias, the individual may try to cover up the disorder with additional movements that make the disorder seem voluntary and therefore not a product of mental illness. The result can be very confusing and even distressing to the observer. I have read several medical records in which... 

Drug-induced akathisia, dystonia, and parkinsonism can produce extreme discomfort. They can be disabling and feel like torture (see chapter 3 for details). In brief, akathisia can become an inner torment and anguish that drives the individual into hyperactivity. 

Acute dystonic reactions are dramatic, acute-onset muscular spasms that occur within the first 24-48 hours after starting therapy, or in a few cases when the dosage is increased. A circadian pattern of acute dystonic reactions has been described (198). Men are more susceptible than women to this reaction, and the young more so than the elderly (199). Drug-induced dystonia can also be... 

A 35-year-old woman with schizophrenia developed acute respiratory distress and laryngeal stridor (196). Neuroleptic drug-induced laryngeal dystonia was diagnosed. She was given biperiden lactate 10 mg intramuscularly and her symptoms resolved fully within 30 minutes. On the advice of a psychiatrist, and to sedate her for admission to a psychiatric hospital, her mother had secretly put 50 drops of haloperidol (10 mg/ml) in her food 1 hour before the symptoms appeared. 

In addition, the authors reviewed 26 previously published cases of neuroleptic drug-induced laryngeal dystonia. They suggested that this condition could be the cause of... 

Angus JW, Simpson GM. Hysteria and drug-induced dystonia. Acta Psychiatr Scand Suppl 1970 212 52-8. 

Christodoulou C, Kalaitzi C. Antipsychotic drug-induced acute laryngeal dystonia two case reports and a mini review. J Psychopharmacol 2005 19 307-12. 

Raja M. Managing antipsychotic-induced acute and tardive dystonia. Drug Saf 1998 19(l) 57-72. 

Looper KJ, Chouinard G. Beneficial effects of combined L-dopa and central anticholinergic in a patient with severe drug-induced parkinsonism and tardive dystonia. Can J Psychiatry 1998 43(6) 646-7. 

Extrapyramidal Symptoms. Acute ex-trapyramidal symptoms (EPS) consists of drug-induced parkinsonism (DIP), akathisia, and dystonia. Because of a common link to diminished CNS dopamine function at D2 receptors, DIP and idiopathic Parkinson s disease are indistinguishable. As in Parkinson s... 

Muscle spasms, particularly those associated with multiple sclerosis or dystonia, may improve significantly with cannabinoid therapy. However, while CBD has been found effective in combination with standard therapy (which was insufficient to adequately control dystonic motor symptoms without CBD), both A -THC and marijuana were found to have untoward side-effects at the doses required to reduce muscle tone. Additionally, CBD may prove beneficial for other hyperkinetic movement disorders such as drug-induced dystonia and possibly tardive dyskinesia. 

Drug-induced dystonia has been reported after the use of artesunate- -amodiaqidne [16 ]. 

Fajolu IB, Lesi FEA. Drug-induced acute dystonia in a 7 year old child following the use of artesunate-amodiaquine a case report. Int J Risk Saf Med 2010 22 111. ... 

Derinoz O, Caglar AA. Drug-induced movement disorders in children at paediatric emergency department dystonia. Emerg Med J 2013 30(2) 130-3. 

Parkinson s disease (PD) is a hypokinetic movement disorder 766 Huntington s disease is a hyperkinetic movement disorder 771 Wilson s disease is a disease of copper accumulation 773 Dystonia is characterized by sustained muscle contractions 775 Many drugs and toxins induce movement disorders 776... 

Van Harten PN, Hoek HW, Kahn RS. Acute dystonia induced by drug treatment. BMJ 1999 319(7210) 623-626. 

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