Extrapyramidal disorder

Clozapine is a neuroleptic, which expresses antipsychotic and sedative action. It does not cause general depression and extrapyramidal disorders. It is used for severe and chronic... 

Adjunctive therapy in all forms of parkinsonism (postencephalitic, arteriosclerotic and idiopathic) and in the control of drug-induced extrapyramidal disorders. 

Drug-induced extrapyramidal disorders-Administer 1 to 4 mg once or twice/day. 

Extrapyramidal disorders which develop soon after initiating treatment with neuroleptic drugs are likely to be transient. A dosage of 1 to 2 mg orally 2 or 3 times a day usually provides relief within 1 or 2 days. After 1 or 2 weeks, withdraw drug to determine its continued need. If such disorders recur, reinstitute benztropine. 

Drug-induced extrapyramidal disorders- Start with a single 1 mg dose. Daily... 

Botulinum toxin is used clinically in the treatment of blepharospasm, writer s cramp, spasticities of various origins, and rigidity due to extrapyramidal disorders. It is also used to treat gustatory sweating and cosmetically to decrease facial wrinkles. Botulinum toxin A Botox, Oculinum) injected intramuscularly produces functional denervation that lasts about 3 months. Clinical benefit is seen within 1 to 3 days. Adverse effects range from diplopia and irritation with blepharospasm to muscle weakness with dystonias. 

Vincken WG, Gauthier SG, Dollfuss RE, Hanson RE, Darauay CM, Cosio MG. Involvement of upper-airway muscles in extrapyramidal disorders a cause of airflow limitation. N Engl J Med 1984 311 438442. 

Extrapyramidal disorder characterized by reduction in velocity of normal movements, paucity of movements and inability to initiate normal movements. Cardinal sign of Parkinson s disease. 

Combined treatment with atypical neuroleptic drugs and SSRIs is common and case reports have suggested that SSRIs can increase risperidone concentrations and increase the risk of extrapyramidal disorders (SEDA-23, 18). 

In a 7-month open study 39 patients (mean age 52 years 26% men) taking olanzapine (mean dose 15 mg/ day) had limited non-significant improvement in the Wisconsin Card Sorting Test for cognitive assessment (48). The following adverse events were considered to have been treatment-related weight gain (n = 6), extrapyramidal disorders (n = 2), and increased appetite, weakness, and confusion (n = 1 each). 

Risperidone has also been used in combination with topiramate in a Spanish multicenter study in 58 patients (28 men and 30 women mean age 41 years) with bipolar I disorder, with manic but not mixed episodes (20). Risperidone (mean dose 2.7 mg/day) and topiramate (mean dose 236 mg/day) were started with a maximum 48-hour time difference risperidone was used for acute manic symptoms and topiramate for longer-term stabilization and prevention of relapse. The incidence of any adverse event was 64%, mostly somnolence, paresthesia, dizziness, tremor, weight loss (n = 27 mean change -1.1 kg), extrapyramidal disorders, gastrointestinal effects, and cognitive disturbances. One patient developed tardive dyskinesia during the study and there were five dropouts because of adverse effects adverse effects that required withdrawal of risperidone but not topiramate were amenorrhea (n = 3) and sexual dysfunction (n = 1). 

The authors suggested a causal association between use of marijuana and extrapyramidal disorders. The research literature contains evidence that the endogenous canna-binoid system plays a role in basal ganglia transmission circuitry, possibly by interfering with dopamine reuptake. Furthermore, central cannabinoid receptors are located in two areas that regulate motor activity, the lateral globus pallidus and substantia nigra (89). 

Chen K-M, Chase TN (1986) Parkinsonism-dementia. In Handbook of Clinical Neurology. Extrapyramidal Disorders (Vinken PJ, Bruyn GW, Klawans HL, eds), pp 167-183. Amsterdam Elsevier. 

Albendazole has sometimes aggravated extrapyramidal disorders or precipitated seizures in patients with prior epileptic symptoms. The risk of intracranial hypertension has led some to suggest that glucocorticoids should be given preventively when using albendazole in neurocysticercosis (24) however, dexamethasone can interact with albendazole, increasing its plasma concentrations (25), and it is not clear whether this might produce new problems. 

The safety, tolerability, and efficacy of risperidone have been assessed in 103 patients with schizophrenia (52 men and 51 women) aged 65 years or older in an open, multicenter, 12-week study (141). The mean risperidone dose at end-point was 2.4 mg/day. Adverse events occurred in 91 patients and included dizziness (n = 23), insomnia (n = 17), agitation (n = 15), somnolence (n = 15), injury (n = 12), constipation (n = 11), and extrapyramidal disorders (n = 10) 11 patients withdrew because of adverse events. Among the 91 patients with normal baseline QTc intervals (below 450 ms), 9 had a prolonged QTc interval during the study (range 450-516 ms). 

Barbeau A. 1984. Manganese and extrapyramidal disorders (a critical review and tribute to Dr. George C. Cotzias). Neurotoxicology 5 13-35. 

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