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.

• Cerebral Palsy

  palsy G801Spastic diplegic cerebral palsy G802Spastic hemiplegic cerebral palsy G803Athetoid cerebral palsy G804Ataxic cerebral palsy G808Other cerebral palsy G809Cerebral palsy, unspecified G8220Paraplegia, unspecified G8221Paraplegia, complete G8222Paraplegia [cms.gov]

  palsy ( G80.3 ) Dystonia Code History 2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016) : No change 2018 (effective 10/1/2017) : No change 2019 (effective 10/1/2018) : No change ICD-10-CM Codes Adjacent [icd10data.com]

  […] of cerebral palsy Huntington's disease MS ( multiple sclerosis ) some infections, such as encephalitis, TB ( tuberculosis ), or HIV stroke traumatic brain or spine injury Wilson's disease Parkinson's disease is also a neurodegenerative condition that [medicalnewstoday.com]

  It may be misdiagnosed as cerebral palsy or parkinsonism. Several genes have been associated with Dopa-responsive Dystonia. [brainfoundation.org.au]

  There are numerous clear-cut neuromotor diseases that exhibit bruxism as a feature of the disease (eg, cerebral palsy). The disorder of periodic limb movements is similar to an OMD, except that it occurs in the leg muscles. [pocketdentistry.com]

• 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]

• 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]

• 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]

• Chorea

  G255Other chorea G2561Drug induced tics G2569Other tics of organic origin G2570Drug induced movement disorder, unspecified G2571Drug induced akathisia G2579Other drug induced movement disorders G2582Stiff-man syndrome G2583Benign shuddering attacks G2589Other [cms.gov]

  Finally a combination of tetrabenazine and clozapine was successful in treatment of both chorea and dystonia. According to this observation, acute dystonia may occur in Huntington’s disease as a consequence of neuroleptic treatment. © 1989 S. [karger.com]

  Involuntary movements, including tremor, chorea, athetosis, dyskinesias, dystonia, myoclonus, tics, ballismus and akathisia, may be symptoms of primary neurologic disease or occur secondary to pharmacotherapy (Table 1). [benzosupport.org]

  Other types of tardive dyskinesia include facial tics and irregular, dance-like movements called choreas. [dystonia.org.uk]

  DIMDs can also occur from: Lithium, which can cause tremors or chorea; Stimulants (e.g., amphetamines), which can cause tremor, tics, dystonia, and dyskinesia; Selective-serotonin reuptake inhibitors (SSRIs), which can cause tremors, akathisia, and possible [the-hospitalist.org]

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]

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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.