Facial tremor

The adverse reactions associated widi metoclopramide are usually mild. Higher doses or prolonged administration may produce central nervous system (CNS) symptoms, such as drowsiness, dizziness, Parkinson-like symptoms (tremor, mask-like facial expression, muscle rigidity), depression, facial grimacing, motor restlessness, and involuntary movements of die eyes, face, or limbs. Dexpandienol administration may cause itching, difficulty breadiing, and urticaria... 

The pro- and anticonvulsant effects of the phencyclinoids were studied by assessing their ability to increase or decrease the intensity of electrically-induced convulsions. A 32 mA, 0.2-second stimulus was delivered via corneal electrodes with a constant-current electroshock apparatus. The shock parameters were chosen to produce a convulsion intensity of "3" on a five-point rating scale as follows 0 = stunned only, 1 = facial and vibrissae tremor, 2 = clonic forepaw treading, 3 = tonic forelimb extension, 4 = tonic forelimb and hindlimb extension, and 5 = death. Thus, both increases and decreases in the convulsion intensity subsequent to drug administration could be observed. 

All infants developed deviant neurobehavioral symptoms within the first 24 hours of life. Most commonly, the neonates were found to have symptoms of irritability, tremors, and hypertonicity. Bizarre eye movements and staring spells were seen in 25 percent of infants. Poor sucking, lethargy, diarrhea, and facial twitching, symptoms commonly associated with prenatal opiate exposure, were seen infrequently in these PCP-addicted infants. 

McCarron s paper (this volume) describes the behaviors of 1,000 adults admitted to an inpatient service with acute symptoms of PCP intoxication. She states that some of the patients have appropriate behavior while many have mute and staring episodes, bizarre facial grimacing, localized dystonic reactions, rigidity, tremors, coarse jerky movements, and nystagmus. Thus, there is similarity between the acutely intoxicated adult s behavior and that of the newborn with a positive urine toxic screen for PCP. 

Acute exposure of sheep to 500 mg/kg hexachloroethane resulted in tremors of the facial muscles immediately after the exposure (Fowler 1969b). In sheep that were suffering from liver fluke infections, the neurotoxicity of hexachloroethane was even more pronounced. A dose of 170 mg/kg given for treatment of the fluke infection rendered 2 of 15 sheep immobile and unable to stand on the day after treatment, and a dose of 338 mg/kg affected 6 of 15 animals. Tremors of the facial muscles, neck, and forelimbs were apparent. The animals that were able to stand had a staggering gait, and when they fell, they were unable to... 

Clinical signs of neurotoxicity (tremors and ataxia) have been observed in sheep, dogs, and rats dining or immediately after both oral and inhalation exposure. Sometimes tremors developed early in the treatment regime and other times the tremors became apparent only after repeated exposures. Fluke-infected sheep experienced tremors of the facial muscles, neck, and forelimbs and were unable to stand after treatment with hexachloroethane. They were successfully treated with calcium borogluconate. This suggests that the neurological action of hexachloroethane may be the result of interference with the availability of calcium within excitable cells. 

Neurological Effects. No studies were located regarding neurological effects in humans after exposure to hexachloroethane. Inhalation, oral, and dermal exposure of animals to moderate or high doses (260 ppm, 5,900 ppm, 375 mg/kg/day, 750 mg/kg/day) resulted in hyperactivity, tremors, fasciculation of the facial muscles, ataxia, convulsions, and/or prostration (Fowler 1969b NTP 1977, 1989 Southcott 1951 Weeks et al. 1979). Reduced motor activity has also been observed following oral exposure of pregnant rats (167 mg/kg/day) (Shimizu et al. 1992). Inhalation exposure of rats to 260 ppm for 6 weeks did not have any effect on spontaneous motor activity or shock avoidance behavior (Weeks et al. 1979). 

Acute oral doses (500 mg/kg) given to healthy sheep caused tremors of the facial muscles (Fowler 1969b) several liver-fluke-infected sheep experienced prostration with even lower doses (170 or 338 mg/kg) (Southcott 1951). Treatment of sheep with calcium relieved the clinical signs of neurotoxicity, suggesting that cellular availability of calcium ion may be related to the neuromuscular symptoms noted (Southcott 1951). Therefore, mechanistic studies of neuromuscular impulse transmission and cognitive function in animals would be useful. These neurological studies should examine the effects of different concentrations of hexachloroethane in several species. 

Rabbit (NS) 19-70 x total, 5 d/wk 2 hr/d 20-42 F (convulsions, tremors, twitching of facial muscles, brain necrosis) Treon et al. 1955 Endrin... 

Soma compound Muscle relaxant Analgesic Tab Carisoprodol 200 mg, aspirin 325 mg 1 -2 tab qid pm vertigo, ataxia, tremor, facial flushing, pancytopenia (rare). 

Rats exposed to 5900 ppm for 8 hours showed ataxia, tremor, and convulsions and two of six died. At 260ppm for 8 hours there were no toxic signs, but repeated exposure to this concentration 6 hours/day, 5 days/week caused tremor, red exudate around the eyes, and some deaths after 4 weeks. Dogs exposed at 2 60 ppm developed tremor, ataxia, hypersalivation, and facial muscular fasiculations and held their eyelids closed during the exposure three of four survived 6 weeks of repeated exposures. No treatment-related effects were found in a number of species repeatedly exposed at 48 ppm. ... 

Most antipsychotics and especially the piperazines and the butyrophenones can cause extrapyra-midal symptoms. Blockade of dopamine receptors mainly in the corpus striatum is held responsible for these extrapyramidal effects. They may become manifest as a variety of clinical symptoms and it should be noted that within 24 8 hours after the beginning of treatment acute dystonic reactions like torticollis, facial grimacing and opisthotonos may occur. Parkinsonism-like symptoms such as bradyki-nesia, rigidity and tremor occur after weeks or months of therapy and are more common in the elderly. Motor restlessness, i.e. akathisia, also mostly occurs not before weeks or months after starting therapy. The tendency of an antipsychotic agent to produce extrapyramidal symptoms appears to be inversely related to its ability to block cholinergic receptors. 

Relief of symptoms, such as an improvement of masklike facial expression, muscular rigidity, shuffling gait, and resting tremors of the hands and head... 

Weight loss, anxiety, cough, facial flushing, urinary frequency, back pain, tremor Serious Reactions... 

The most common extrapyramidal reaction is akathisia, characterized by motor restlessness and anxiety. Akinesia, marked by rigidity, tremor, i ncreased sal ivat ion, mask-like facial expression, and reduced voluntary movements, occurs less frequently. Dystonias, including torticollis, opisthotonos, and oculogyric crisis, occur rarely. 

Abrupt withdrawal of the drug after long-term use may produce asthenia, facial flushing, diaphoresis, vomiting, and tremor. 

All of the CNS depressants can pass through the placenta. Newborn babies with dependent mothers may be physically dependent themselves and have withdrawal symptoms that include tremors, irritability, hyperactivity, and feeding and breathing problems. There may be birth defects such as fetal alcohol syndrome, which consists of abnormal facial features, a small head, mental retardation, and poor coordination. 

Adverse effects include abdominal pain, chest pain, facial edema, nausea, dry mouth, constipation, diarrhoea, anorexia, mouth ulcer, thirst, myalgia, arthralgia, anxiety, disturbed concentration, dizziness, nervousness, tremor, dysphoria, rhinitis, increased cough, pharyngitis, sinusitis, dyspnea, epistaxis, agitation, insomnia and headache. 

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