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.

• Antipsychotic Agent

  We also learned that newer antipsychotic agents, the so-called second-generation antipsychotics, do not cause EPS. [the-hospitalist.org]

  Neuroleptics include both conventional or typical antipsychotic agents, such as chlorpromazine (Thorazine), haloperidol (Haldol), and fluphenazine (Prolixin), as well as the newer, or atypical, antipsychotic agents such as clozapine (Clozaril), risperidone [minddisorders.com]

  Patients requiring ongoing antipyschotic treatment may require long-term anticholinergic treatment (e.g. benztropine) to prevent symptoms, or an alternative antipsychotic agent (e.g. a newer atypical agent) may be tried. [lifeinthefastlane.com]

  Other strategies utilized in the management of DIP include dosage reduction, switching to an atypical antipsychotic agent, and the use of amantadine and antimuscarinic agents. [uspharmacist.com]

• Shivering

  Early symptoms are like, loss of muscle coordination, trembling, shivering, pain in limbs and joints etc. Drug-actuated intense dystonic responses are a typical presentation to the crisis division. [buydiazepam10mg.com]

• Dyspnea

  May also lead to eye deviation, dysphagia, dysarthria, or even dyspnea. Buccolingual dystonia is the most common form. [ Hooker, 1988 ] Consists of dysarthria, mutism, trismus, tongue protruding or retracting, facial grimacing / distortions. [pedemmorsels.com]

  Layryngeal dystonia — a rare but potentially life-threatening variant characterised by throat pain, dyspnea, stridor and dysphonia. [lifeinthefastlane.com]

  […] symptoms can take up to 36 h to appear, and are usually in the form of involuntary limb movements, facial grimacing, torticollis, oculogyric crisis, rhythmic protrusion of the tongue, bulbar type of speech, trismus, opisthotonus and rarely stridor and dyspnea [bmcresnotes.biomedcentral.com]

• Yawning

  Overactive movement of the muscles of the larynx (excessive closure or opening of the vocal cords) occurs during specific vocal activities such as speaking but not during laughing or yawning. [brainfoundation.org.au]

  Improved speech is noted during emotional or physiological states for example joy, anger or following yawning. Shouting or stress usually makes the condition worse. Treatment can be difficult and is dependent on the individual. [netdoctor.co.uk]

• Hoarseness

  The patient may sound hoarse, breathless, anxious or groaning. In the abductor type, there is an overcontraction of the muscles that separate the vocal cords, resulting in a choppy and breathy whispering voice pattern. [netdoctor.co.uk]

  Spasmodic dysphonia /Laryngeal dystonia muscles of larynx Causes the voice to sound broken, become hoarse, sometimes reducing it to a whisper. [en.wikipedia.org]

• Nausea

  Some drugs that are used for nausea and gastrointestinal problems are also neuroleptic so they can cause the same problems – drugs like Reglan and Stematil. These can induce acute dystonia. [lifeinpain.org]

  Dopamine causes nausea and vomiting by stimulating the medullary chemoreceptor trigger zone. [bmcresnotes.biomedcentral.com]

  Most commonly, these are antipsychotics or anti nausea drugs which block the dopamine receptors in the brain. Dopamine is found in the basal ganglia and is responsible for normal movement. [movementdisorders.ufhealth.org]

  Some DRBs are used to treat nausea and dizziness, not psychosis. If the symptoms described below appear after taking oral medication, it is essential to discuss this immediately with the doctor who prescribed them. [dystonia.org.uk]

  Consider recent, or prior, exposure to causative drugs (antipsychotics or nausea medicines) - even a single dose. Consider infectious or toxin exposures. Evaluate for any events that could lower seizure threshold. 2. [clinicaladvisor.com]

• Hypertension

  In our case, drug-drug interaction is unlikely; the patient is taking only an angiotensin-converting enzyme inhibitor, quinapril, for hypertension and insulin for diabetes mellitus. [antidepressantsfacts.com]

• Blepharospasm

  Blepharospasm is often aggravated by sunlight. [brainfoundation.org.au]

  G24.09 - Other drug induced dystonia ICD-10-CM Siblings (same level / similar specificity) of G24.0: G24.1 - Genetic torsion dystonia G24.2 - Idiopathic nonfamilial dystonia G24.3 - Spasmodic torticollis G24.4 - Idiopathic orofacial dystonia G24.5 - Blepharospasm [emedcodes.com]

  Dystonia G24.0 Drug induced dystonia G24.01 Drug induced subacute dyskinesia G24.09 Other drug induced dystonia G24.1 Genetic torsion dystonia G24.2 Idiopathic nonfamilial dystonia G24.3 Spasmodic torticollis G24.4 Idiopathic orofacial dystonia G24.5 Blepharospasm [healthprovidersdata.com]

  Blepharospasm Blepharospasm affects the musculature of the eye. The muscles around the eyes are affected. [medicalnewstoday.com]

  Blepharospasm Blepharospasm is uncontrollable and often painful muscle contractions around the eye, leading to blinking and closure of the eyelids. [netdoctor.co.uk]

• Blurred Vision

  These include dry mouth, constipation, blurred vision, urinary retention (more common in older men), confusion, memory loss, and even hallucinations. [clinicaladvisor.com]

  Side-effects include dry mouth, blurred vision, constipation, difficulty in urinating, memory impairment or confusion. But your doctor will increase the dosage slowly to reduce the chance of side-effects. [netdoctor.co.uk]

  vision, digestive problems, and short temper. [en.wikipedia.org]

• Eye Irritation

  Injections around the eye may produce drooping of the eyelid or weakness of the eye muscles causing double vision or eye irritation. The side-effects usually disappear in a week or so and are unpredictable. [netdoctor.co.uk]

• Photophobia

  Symptoms might include: photophobia (sensitivity to light) irritation in the eye(s) excessive blinking, often uncontrollable eyes close uncontrollably People with severe symptoms may find it impossible to open their eyes for several minutes. [medicalnewstoday.com]

• Torticollis

  […] subacute dyskinesia G24.02 - Drug induced acute dystonia G24.09 - Other drug induced dystonia ICD-10-CM Siblings (same level / similar specificity) of G24.0: G24.1 - Genetic torsion dystonia G24.2 - Idiopathic nonfamilial dystonia G24.3 - Spasmodic torticollis [emedcodes.com]

  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 while torticollis results from sternocleidomastoid [symptoma.com]

  We report a case of acute dystonic reaction following the use of artesunate-amodiaquine in a 7 year old boy who presented with tongue protrusion, inability to talk, torticollis, opistothonus and laryngeal spasm. [content.iospress.com]

  The head may tilt (laterocollis) or twist to one side (rotational torticollis), forward (anterocollis) or backward (retrocollis). The movements may be sustained or jerky (myoclonic torticollis). [netdoctor.co.uk]

  Similar Codes ICD-10 Code ICD-10 Description G24 Dystonia G24.0 Drug induced dystonia G24.01 Drug induced subacute dyskinesia G24.09 Other drug induced dystonia G24.1 Genetic torsion dystonia G24.2 Idiopathic nonfamilial dystonia G24.3 Spasmodic torticollis [healthprovidersdata.com]

• Muscle Spasm

  This information supplemented our own research into extrapyramidal side effects induced by antipsychotic drugs. 3 – 5 Prevalence and risk factors Acute dystonia induced by antipsychotic drugs is described as “sustained abnormal postures or muscle spasms [bmj.com]

  Hemifacial spasm The individual experiences spasms in the muscles on one side of the face. Symptoms may be more prominent when the individual is under mental stress or physically tired. Laryngeal dystonia The muscles in the voice box (larynx) spasm. [medicalnewstoday.com]

  Benzodiazepines relieve muscle spasm of any etiology, and do not confirm a diagnosis. Switch to one of the newer antipsychotics like clozapine, olanzapine, risperidone, etc; should be considered. [clinicaladvisor.com]

  Doctors use medicines, Botox injections, surgery, physical therapy, and other treatments to reduce or eliminate muscle spasms and pain. [icdlist.com]

  Both tardive dystonia and other tardive dyskinesias typically involve (but are not necessarily limited to) the muscles of the face. Symptoms may also include muscle spasms of the neck, trunk, and/or arms. [dystonia-foundation.org]

• Muscle Spasticity

  Baclofen A baclofen pump has been used to treat patients of all ages exhibiting muscle spasticity along with dystonia. The pump delivers baclofen via a catheter to the thecal space surrounding the spinal cord. [en.wikipedia.org]

• Leg Cramp

  Some early symptoms include: A "dragging leg" Cramping of the foot Involuntary pulling of the neck Uncontrollable blinking Speech difficulties Stress or fatigue may bring on the symptoms or cause them to worsen. [webmd.com]

• Dystonia

  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]

  Neuroleptic-induced tardive dystonia is frequently refractory to therapy. We describe a 13-year-old girl with neuronal ceroid-lipofuscinosis who developed dystonia after beginning treatment with thioridazine for acute psychosis. [ncbi.nlm.nih.gov]

  Similar Codes ICD-10 Code ICD-10 Description G24 Dystonia G24.0 Drug induced dystonia G24.01 Drug induced subacute dyskinesia G24.09 Other drug induced dystonia G24.1 Genetic torsion dystonia G24.2 Idiopathic nonfamilial dystonia G24.3 Spasmodic torticollis [healthprovidersdata.com]

  G24.9 - Dystonia, unspecified [emedcodes.com]

• Involuntary Movements

  Symptoms can include one or more of involuntary movements of the face and/or mouth (oromandibular dystonia see above), involuntary eye closure (blepharospasm), voice problems, involuntary twisting or movement of the neck (cervical dystonia) and contortion [dystonia.org.uk]

  Constant weekly monitoring for early detection of abnormal involuntary movements is an important role of the nurse. [benzosupport.org]

  In this form of dyskinesia, the involuntary movements are tardive, meaning they have a slow or belated onset. [icd.codes]

  Tardive dystonia is a form of tardive dyskinesia, which includes involuntary movements that resemble multiple movement disorders. [dystonia-foundation.org]

  Neuroleptic-induced tardive dyskinesia manifests itself in involuntary movements of the tongue, jaw, trunk, or extremities. [minddisorders.com]

• Stroke

  NIH: National Institute of Neurological Disorders and Stroke Botulinum toxin injection - larynx (Medical Encyclopedia) Spasmodic dysphonia (Medical Encyclopedia) Torticollis (Medical Encyclopedia) [ Read More ] [icdlist.com]

  The National Institutes of Neurological Disorders and Stroke conducts and supports a broad range of research on movement disorders including tardive dystonias and dyskinesias. [dystonia-foundation.org]

  Vascular Dementia SpringerLink Vascular dementia VaD, post-stroke dementia, multi-infarct dementia, strategic infarct dementia, arteriosclerotic dementia, Binswangers disease, tat … How Harmful is Marijuana Marijuana As Medicine The … Read chapter How [prophecology.com]

  Deep space neck abscess ( Retropharyngeal abscess ) Tetanus Seizure Calcium deficiency Drug intoxication Meningitis / Encephalitis Stroke Conversion disorder Sean M. [pedemmorsels.com]

  The damage could be the result of: Brain trauma Stroke Tumor Oxygen deprivation Infection Drug reactions Poisoning caused by lead or carbon monoxide Idiopathic or primary dystonia is often inherited from a parent. [webmd.com]

• Extrapyramidal Symptoms

  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 https://doi.org/10.11477/mf.1405100414 Copyright © 2004, Igaku-Shoin [webview.isho.jp]

  +2348023076154; E-mail: [email protected] 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]

  Symptoms can include tremors, voice problems or a dragging foot. Symptoms ... Extrapyramidal symptoms after exposure to calcium channel blocker-flunarizine or cinnarizine. [medicbind.com]

  She improved in her psychotic symptoms over 2 months with no extrapyramidal symptoms, normal electrocardiogram, and other baseline investigations. [jpharmacol.com]

  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]

• Confusion

  These include dry mouth, constipation, blurred vision, urinary retention (more common in older men), confusion, memory loss, and even hallucinations. [clinicaladvisor.com]

  All patients taking antidepressants should be observed for signs of hyponatraemia (dizziness, nausea, lethargy, confusion cramps and seizures). [bpac.org.nz]

  Easily confused with psychiatric symptoms such as agitation, hyperactivity and anxiety ----------------------------------------------------------- * Central stimulants that act as indirect dopamine agonists such as amphetamine * Levodopa, a precursor [benzosupport.org]

  […] injection Child: 0.02mg/kg to maximum of 1mg Benzodiazepines: Second line treatment help relieve muscle spasm and anxiety best used for acute dystonic reactions that are slow to resolve following benztropine administration — early use may lead to diagnostic confusion [lifeinthefastlane.com]

  The side-effects depend on the dose, but they may include drowsiness, confusion and light-headedness. Withdrawal symptoms also occur which is why the dose should be lowered slowly. [netdoctor.co.uk]

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.

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]

At best, the prognosis for patients with tardive dyskinesia is poor. [benzosupport.org]

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]

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]

Learning Bite Acute dystonia should be treated with IM/IV anticholinergics (e.g. procyclidine) Prognosis & Followup strategies Acute dystonia is commonly induced by anti-psychotics, anti-emetics or antidepressants but has been attributed less commonly [rcemlearning.co.uk]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

Patient should have basic electrolytes checked including calcium and magnesium, toxicology screen, and complete blood count (CBC) for infectious etiologies. [clinicaladvisor.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]

Codes with this note are Etiology codes and must be followed by a Manifestation code or codes. [icd.codes]

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]

Summary Epidemiology The prevalence is unknown. Fewer than 100 patients have been described worldwide to date. [orpha.net]

State Epidemiologic Profile on Substance Use, Abuse, and Dependency--2007-2011. Alaska Department of Health and Social Services. Released November 7, 2013. 8. State of Alaska, Office of the Governor. [ibis.dhss.alaska.gov]

Epidemiology Frequency United States The incidence of acute dystonic reactions varies according to individual susceptibility, drug identity, dose, and duration of therapy. [emedicine.medscape.com]

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]

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]

Pathophysiology Although dystonic reactions are occasionally dose related, these reactions are more often idiosyncratic and unpredictable. [emedicine.medscape.com]

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]

Like idiopathic and tardive dystonia, the pathophysiology of acute dystonic reactions remains obscure. [benzosupport.org]

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]

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]

For tardive dystonia, prevention is the most important treatment since few pharmacologic treatments have proven efficacy. Prevention also is the key to managing akathisia. [the-hospitalist.org]

Treatments In an attempt to prevent acute dystonia from developing, physicians may prescribe a preventative medication along with the antipsychotic (see "Prevention," below). [minddisorders.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]

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.