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Drug-induced Dystonia

Drug-induced dystonia is a movement disorder caused primarily by the effects of antipsychotic and antiemetic drugs on the extrapyramidal system. It causes a variety of involuntary and abnormal movements and postures.


Presentation

Drug-induced dystonia is reversible and presents as acute, disorganized contraction of muscle groups. It generally occurs soon after the administration of antipsychotic, antiemetic, antidepressant and antiepileptic drugs, however other drugs have also been known to induce the condition [1] [2] [3]. It is thought that this is due to the drugs' inhibitory effect on the dopamine system in the central nervous system. It appears commonly when the drug is initiated or when the dose of the drug is increased. Higher doses and greater potency of causative drugs, particularly neuroleptic drugs are associated with as higher incidence [4]. In addition, first-generation antipsychotics, such as haloperidol, have been implicated more than second-generation antipsychotics. Symptoms appear within hours of administration of the initial dose of antipsychotics, and up to one month after antidepressants are started [5]. Younger patients, concurrent substance use, particularly alcohol and cocaine, family history of dystonia are associated with a higher risk of the condition [6].

Drug-induced dystonia is seldom a source of fatalities [7]. It does, however, cause significant patient distress, and is frequently misdiagnosed [8]. It usually involves the muscles of the face and neck but is not restricted to these. Episodes are characterized by sustained uncontrollable motions that may or may not be heralded by voluntary movement. Facially, the muscles of the eye can be affected, causing what may appear to be excessive blinking. The muscles may also constantly contract, forcing the gaze to remain in a certain direction resulting in an oculogyric crisis. Involvement of the facial muscles causes twitching of the lips, dysarthria, dysphonia and buccolingual crisis; if laryngeal or pharyngeal musculature are affected then there could be airway compromise [9] while torticollis results from sternocleidomastoid muscle involvement.

On the torso, distortion of the spine, opisthotonus, as well as a tortipelvic crisis, which involves rigidity of the pelvic and abdominal musculature, can occur. Any muscle group can be affected, and it can eventually become painful with the formation of contractures [10]. Moreover, a serious and debilitating form of the disorder called tardive dystonia may follow.

Anemia
  • […] drug-induced hemolytic anemia drug-induced hemolytic anemia Drug-Induced Hepatitis drug-induced hepatopathy Drug-Induced Hypersensitivity Syndrome drug-induced hypoglycemia Drug-Induced Idiosyncratic Liver Disease drug-induced immune hemolytic anemia[encyclopedia2.thefreedictionary.com]
Dentist
  • Although the dentist will not be doing this examination, it is necessary to identify whether a patient has had a correct assessment before participating in the management of the patient.[pocketdentistry.com]
Diarrhea
  • Angioedema (Medical Encyclopedia) Drug allergies (Medical Encyclopedia) Drug-induced diarrhea (Medical Encyclopedia) Drug-induced tremor (Medical Encyclopedia) Taking multiple medicines safely (Medical Encyclopedia) [ Read More ] Dystonia Dystonia is[icdlist.com]
Gingival Overgrowth
  • […] drug-induced constipation drug-induced cystitis drug-induced disease Drug-induced dystonia Drug-Induced Extra-Pyramidal Symptoms Scale drug-induced gingival hyperplasia drug-induced gingival hyperplasia drug-induced gingival hyperplasia Drug-Induced Gingival[encyclopedia2.thefreedictionary.com]
Vascular Disease
  • Focal dystonias can be primary or secondary; the secondary form of dystonias occurs as a result of a trauma (peripheral or central), brainstem lesion, systemic disease (eg, multiple sclerosis, Parkinson’s disease), vascular disease (eg, basal ganglia[pocketdentistry.com]
Fracture
  • There are many articles that describe the clinical presentation and consequences of bruxism; most agree that the single most effective way to protect the teeth from progressive attrition, fracture, or clenching-induced pulpitis is to fabricate an occlusal[pocketdentistry.com]
Dermatitis
  • .- ) blood disorders ( D56 - D76 ) contact dermatitis ( L23 - L25 ) dermatitis due to substances taken internally ( L27.- ) nephropathy ( N14.0- N14.2 ) Includes adverse effect of correct substance properly administered poisoning by overdose of substance[icd10data.com]
Dystonia
  • The highest frequencies of dystonia occurred among recipients of haloperidol and the long-acting injectable fluphenazines. For all patients at risk, dystonia was more common in men and in younger patients.[ncbi.nlm.nih.gov]
  • Moreover, a serious and debilitating form of the disorder called tardive dystonia may follow. There are no tests tailored to diagnose drug-induced dystonia.[symptoma.com]
  • […] dyskinesia (disorder) Drug-induced dystonia Drug-induced dystonia (disorder) Drug-induced orofacial dyskinesia Drug-induced orofacial dyskinesia (disorder) Drug-induced tardive dyskinesia Drug-induced tardive dystonia Major Diagnostic Categories M.D.C[medicbind.com]
Extrapyramidal Symptoms
  • .: 2348023076154; E-mail: iretifajolu@justice.com Abstract: Acute drug induced dystonias are commonly reported with antipsychotic drugs, however there have been reports of extrapyramidal symptoms following the use of 4-aminoquinolones such as chloroquine[content.iospress.com]
  • Extrapyramidal symptoms after exposure to calcium channel blocker-flunarizine or cinnarizine. Jhang KM, Huang JY, Nfor ON, Tung YC, Ku WY, Lee CT, Liaw YP Sertraline induced mandibular dystonia and bruxism.[medicbind.com]
  • symptoms Keyword: Tardive dyskinesia, Neuroleptic-induced movement disorders, Quetiapine, Chronic schizophrenia, Extrapyramidal symptoms pp.49-57 発行日 2004年1月15日 Published Date 2004/1/15 DOI Copyright 2004, Igaku-Shoin Ltd.[webview.isho.jp]
  • Most of us learned in our professional training that neuroleptic agents cause movement disorders, or extrapyramidal symptoms (EPS).1 Neuroleptics, the older class of antipsychotic agents, which includes dopamine receptor blocking agents (DRBA), can cause[the-hospitalist.org]
  • Therefore, physicians must be cautious of prescribing metoclopramide and should consider other antiemetics such as domperidone, which has less frequent extrapyramidal symptoms [ 5 ].[ceemjournal.org]
Rabies
  • […] clinically Chronic neurologic: Parkinson's with dystonia Electrolyte imbalance: low magnesium or calcium (carpopedal spasm) Drug ingestion or poisoning: strychnine Drug withdrawal: benzodiazepines, barbiturates Infection: tetanus, meningitis, encephalitis, rabies[clinicaladvisor.com]
Vocal Tic
  • This includes Bell’s palsy, essential tremor, the focal and multifocal dystonias, the dyskinesias, the motor and vocal tics, and hemifacial spasm.[pocketdentistry.com]

Workup

There are no tests tailored to diagnose drug-induced dystonia. It should be suspected and considered as a possible etiology of symptoms, based on patient history and physical findings. The condition readily responds to treatment and this may indirectly confirm the diagnosis. However, a psychiatrist consult may be required if the diagnosis is doubtful.

Treatment

  • RESULTS: Management and treatment of this movement disorder are often difficult: neuroleptics withdrawal, treatment with benzodiazepines, and anticholinergics are recommended. CONCLUSION: Alternative treatment options are also discussed.[ncbi.nlm.nih.gov]
  • […] can be a side effect of treatment with antipsychotic drugs and other drugs, and it may occur at an early stage of treatment. 1 2 Acute dystonia is often frightening and may seriously disturb the relationship between the doctor and the patient.[bmj.com]
  • Botulinum toxin injections to a particular muscle group are an additional option for treatment. Like the treatment of tardive dystonia, the treatment of other tardive dyskinesias is very specific to the individual patient.[dystonia-foundation.org]
  • There is no clear way to predict which treatments will work for each person. Where other treatments are not effective, deep brain stimulation (DBS) may be an appropriate alternative.[dystonia.org.uk]

Prognosis

  • It is not intended to provide instruction and you should not rely on this information to determine diagnosis, prognosis or a course of treatment. It should not be used in place of a professional consultation with a doctor.[dystonia.org.uk]
  • At best, the prognosis for patients with tardive dyskinesia is poor.[benzosupport.org]
  • Prognosis There is no effect on life expectancy, but quality of life is severely affected. The documents contained in this web site are presented for information purposes only.[orpha.net]
  • Prognosis The prognoses for the early- and intermediate-onset of movement disorders are very good, especially with the option of switching the patient to a newer antipsychotic such as clozapine.[minddisorders.com]
  • We collected the patients’ age, sex, suspected causative drugs, initial diagnosis of the prescribing physician, duration of drug-taking, diagnostic evaluations, treatment methods, and prognosis. Results Seventy-nine patients were enrolled.[ceemjournal.org]

Etiology

  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • It should be suspected and considered as a possible etiology of symptoms, based on patient history and physical findings. The condition readily responds to treatment and this may indirectly confirm the diagnosis.[symptoma.com]
  • Patient should have basic electrolytes checked including calcium and magnesium, toxicology screen, and complete blood count (CBC) for infectious etiologies.[clinicaladvisor.com]
  • Codes with this note are Etiology codes and must be followed by a Manifestation code or codes.[icd.codes]
  • […] the head, neck, and tongue and often occurs as an adverse effect of a medication. dystonia Neurology Involuntary, often acute movement and prolonged contraction of one or more muscles, resulting in twisting body motions, tremor, and abnormal posture Etiology[medical-dictionary.thefreedictionary.com]

Epidemiology

  • In this chapter we review current knowledge regarding the clinical features, epidemiology, pathophysiology, and treatment of acute dystonic reactions (ADRs) and tardive dystonia (TDT).[discovery.ucl.ac.uk]
  • Accessed May 17, 2017. }} Health Program Information The State of Alaska Epidemiologic Profile on Substance Use, Abuse and Dependency is available at: [].[ibis.dhss.alaska.gov]
  • Summary Epidemiology The prevalence is unknown. Fewer than 100 patients have been described worldwide to date.[orpha.net]
  • Our small sample size could not represent all pediatric DID patients, especially in the aspects of treatment and the epidemiology of commonly prescribed causative drugs.[ceemjournal.org]
  • No adequate epidemiologic data exist regarding whether any particular psychiatric diagnosis constitutes a risk factor for the development of tardive reactions to medications; however, the duration of exposure to antipsychotics that is required to cause[pocketdentistry.com]
Sex distribution
Age distribution

Pathophysiology

  • In this chapter we review current knowledge regarding the clinical features, epidemiology, pathophysiology, and treatment of acute dystonic reactions (ADRs) and tardive dystonia (TDT).[discovery.ucl.ac.uk]
  • The pathophysiology of bruxism is unknown. The most cogent theory describes bruxism as a neuromotor dysregulation disorder. This theory proposes that bruxism occurs because of the failure to inhibit jaw motor activity during a sleep state arousal.[pocketdentistry.com]
  • Pathophysiology Although dystonic reactions are occasionally dose related, these reactions are more often idiosyncratic and unpredictable.[emedicine.medscape.com]
  • What is the underlying pathophysiology of this condition? Answer and interpretation Acute dystonic reactions result from an imbalance of dopaminergic and cholinergic neurotransmission.[lifeinthefastlane.com]
  • Like idiopathic and tardive dystonia, the pathophysiology of acute dystonic reactions remains obscure.[benzosupport.org]

Prevention

  • Therefore, every doctor who prescribes dopamine blocking agents should be familiar with the prevalence of and the risk factors for acute dystonia and should know how to prevent and treat the condition.[bmj.com]
  • Avoidable - 0% Emergent - ED Care Needed - Not Preventable/Avoidable - 0% Primary diagnosis of injury 0% Primary diagnosis of mental health problems 0% Primary diagnosis of substance abuse 0% Primary diagnosis of Alcohol 0% Unclassified 100% Health Topic[codelay.com]
  • Now in its second edition, this popular and essential comprehensive resource provides a detailed analysis of how to identify, prevent, and manage drug-induced diseases. Edited by James E. Tisdale and Douglas A.[books.google.de]
  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.com]
  • Categories M.D.C MDC Category Not Assigned For This ICD Code G24.0 Medicare Severity-Diagnosis Related Groups MS-DRG MS-DRG Category Not Assigned For This ICD Code G24.0 Clinical Classifications Software CCS CCS Category Not Assigned For This ICD Code G24.0 Prevention[medicbind.com]

References

Article

  1. Elliott ES, Marken PA, Ruehter VL. Clozapine-associated extrapyramidal reaction. Ann Pharmacother. 2000;34(5):615-618.
  2. Jhee SS, Zarotsky V, Mohaupt SM, Yones CL, Sims SJ. Delayed onset of oculogyric crisis and torticollis with intramuscular haloperidol. Ann Pharmacother. 2003;37(10):1434-1437.
  3. Tekin U, Soyata AZ, Oflaz S. Acute focal dystonic reaction after acute methylphenidate treatment in an adolescent patient. J Clin Psychopharmacol. 2015;35(2):209-211.
  4. van Harten PN, Hoek HW, Kahn RS. Acute dystonia induced by drug treatment. BMJ. 1999;319(7210):623–626.
  5. Hawthorne JM, Caley CF. Extrapyramidal Reactions Associated with Serotonergic Antidepressants. Ann Pharmacother. 2015;49(10):1136-1152.
  6. Zakariaei Z, Taslimi S, Tabatabaiefar MA, Arghand Dargahi M. Bilateral dislocation of temporomandibular joint induced by haloperidol following suicide attempt: a case report. Acta Med Iran. 2012;50(3):213-215.
  7. Freudenreich O. Atypical laryngeal dystonia caused by an antiemetic. Am Fam Physician. 2004;69(7):1623.
  8. Dingli K, Morgan R, Leen C. Tetanus versus acute dystonic reaction caused by metoclopramide. BMJ. 2007;334(7599):899–900.
  9. Munhoz RP, Moscovich M, Araujo PD, Teive HA. Movement disorders emergencies: a review. Arq Neuropsiquiatr. 2012;70(6):453–461.
  10. Dystonias information page. National Institute of Neurological Disorders and Stroke. Accessed March 26,2017.

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Last updated: 2019-07-11 21:02