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Morton A, Mackle C, Pavey J. Akathisia and oculogyric crisis in hyperemesis gravidarum. Obstet Med 2024; 17:129-131. [PMID: 38784181 PMCID: PMC11110745 DOI: 10.1177/1753495x221137942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/22/2022] [Accepted: 10/23/2022] [Indexed: 05/25/2024] Open
Abstract
Hyperemesis gravidarum complicates 0.5-2% of pregnancies. HG is associated with insomnia, significantly increased risks of anxiety and depression, and may be associated with feelings of guilt, social isolation and thoughts of suicidal ideation or termination of pregnancy. Anti-emetic therapy may be complicated by akathisia and dystonic reactions, which may affect the ongoing management of nausea and vomiting. A case of akathisia and oculogyric crisis following the addition of parenteral prochlorperazine to ondansetron and metoclopramide is presented. The treatment options for extrapyramidal side effects with anti-emetics in pregnancy and for ongoing treatment of nausea and vomiting are discussed.
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Affiliation(s)
- Adam Morton
- Obstetric Medicine, Mater Health, Raymond Terrace, South Brisbane, Herston, Queensland, Australia
| | | | - Julian Pavey
- Obstetric Medicine, Mater Health, Brisbane, Australia
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Tanzer T, Pham B, Warren N, Barras M, Kisely S, Siskind D. Overcoming clozapine's adverse events: a narrative review of systematic reviews and meta-analyses. Expert Opin Drug Saf 2024. [PMID: 38814794 DOI: 10.1080/14740338.2024.2362796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/29/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Clozapine is the gold standard treatment for treatment resistant schizophrenia, however adverse events remain a clinical challenge. AREAS COVERED This review presents a narrative synthesis of systematic reviews and meta-analyses that have reported the onset, incidence, prevalence, and management of clozapine's adverse events. We conducted a systematic literature search using PubMed, Embase, PsycINFO, OvidMEDLINE, CINAHL, and the Cochrane Database of Systematic Reviews from inception to April 2024. EXPERT OPINION Effective management of clozapine's adverse events necessitates multi-faceted, individualized, and shared-decision strategies. Despite a lack of high-quality systematic evidence, expert inter-disciplinary solutions are provided to help address a critical need for clinical guidance. This 35-year update offers an evidence-based framework to assist clinicians, patients, and caregivers navigate the adverse events associated with clozapine therapy.
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Affiliation(s)
- Timothy Tanzer
- Princess Alexandra Hospital, Department of Pharmacy, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Betty Pham
- Metro South Community and Oral Health, Department of Pharmacy, Brisbane, Australia
| | - Nicola Warren
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Michael Barras
- Princess Alexandra Hospital, Department of Pharmacy, Brisbane, Australia
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Steve Kisely
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Dan Siskind
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
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Jin P, Fu X, Wang Y, Ma X, Ai W, Xu Y, Li B, Ye Q, Wang G. Oculogyric Crisis in a Wilson's Disease Patient. Mov Disord Clin Pract 2024; 11:315-317. [PMID: 38468560 PMCID: PMC10928320 DOI: 10.1002/mdc3.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Ping Jin
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Xiao‐Ming Fu
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
- Institute of NeurologyAnhui University of Chinese MedicineHefeiChina
| | - Yu Wang
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Xin‐Feng Ma
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Wen‐Long Ai
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Ya‐Yun Xu
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Bo Li
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Qun‐Rong Ye
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
| | - Gong‐Qiang Wang
- Department of NeurologyThe Affiliated Hospital of Institute of Neurology, Anhui University of Chinese MedicineHefeiChina
- Institute of NeurologyAnhui University of Chinese MedicineHefeiChina
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Wikeley S, Bacon I, Greer O, Evans M, Hasan R, Pathak S. New-onset movement disorder in the immediate postpartum period. BMJ Case Rep 2023; 16:e254132. [PMID: 38154870 PMCID: PMC10759129 DOI: 10.1136/bcr-2022-254132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
This case report describes a woman who developed involuntary, uncoordinated movements of her face and limbs following a spontaneous vaginal delivery, complicated by postpartum haemorrhage. Using systematic assessment with multidisciplinary team input, a differential diagnosis was proposed and relevant investigations were undertaken. Atypical eclamptic or generalised seizures were excluded clinically and neuroimaging ruled out an intracranial vascular event such as stroke or venous sinus thrombosis. Local anaesthetic systemic toxicity was managed empirically with intravenous lipid emulsion and intravenous fluids. A diagnosis of drug-induced dyskinesia was made, most likely secondary to ondansetron, with which dystonias and myoclonus have been described. This woman's symptoms were transient and resolved within 2 hours.This case presented a complex differential diagnosis, highlighting the paucity of guidance available. We propose a diagnostic algorithm to aid in the identification of acute involuntary movements in pregnancy and the puerperium.
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Affiliation(s)
- Sarah Wikeley
- Rookery Medical Centre, Royal College of General Practitioners, Newmarket, Suffolk, UK
| | - Imogen Bacon
- Department of Obstetrics & Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Orene Greer
- Department of Obstetrics & Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Matthew Evans
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
| | - Rizwan Hasan
- Department of Anaesthetics, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Hinchingbrooke Park, Huntingdon, Cambridgeshire, UK
| | - Sangeeta Pathak
- Department of Obstetrics & Gynaecology, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Hinchingbrooke Park, Huntingdon, Cambridgeshire, UK
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Lv T, Wu L, Li L, Zhang M, Tan Q, Liu P. Oculogyric crisis symptoms related to risperidone treatment: a case report. BMC Psychiatry 2023; 23:875. [PMID: 38001400 PMCID: PMC10675969 DOI: 10.1186/s12888-023-05379-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Oculogyric crisis (OGC) is a rare focal dystonia of the ocular muscles that not only interferes with patients' medication adherence but also negatively affects the course and prognosis of the primary disease. Early detection and treatment of OGC can improve patients' medication adherence and quality of life. CASE PRESENTATION This paper reports a case of a 19-year-old Asian female with a diagnosis of schizophrenia who was treated intermittently with atypical antipsychotics aripiprazole or risperidone for 2 years, with improvement of psychotic symptoms during the course of medication, and then developed double eye rolling and staring with irritability when treated with risperidone 4 mg/d or 6 mg/d. Then, we changed the medication to clozapine, and the patient's psychotic symptoms were controlled and stable. The symptoms of double eye rolling and gaze disappeared. CONCLUSION Oculogyric crisis (OGC) is a rare focal dystonia of the oculogyric muscle. This case provides clinicians with a basis for the early recognition and management of oculogyric crisis during the use of atypical antipsychotics (risperidone).
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Affiliation(s)
- Tao Lv
- The People's Hospital of Deyang, 173 Section One, North Taishan Road, Deyang, Sichuan, 618000, China.
| | - Liping Wu
- The People's Hospital of Deyang, 173 Section One, North Taishan Road, Deyang, Sichuan, 618000, China
| | - Longlong Li
- The People's Hospital of Deyang, 173 Section One, North Taishan Road, Deyang, Sichuan, 618000, China
| | - Min Zhang
- The People's Hospital of Deyang, 173 Section One, North Taishan Road, Deyang, Sichuan, 618000, China
| | - Qingyu Tan
- The People's Hospital of Deyang, 173 Section One, North Taishan Road, Deyang, Sichuan, 618000, China
| | - Ping Liu
- The People's Hospital of Deyang, 173 Section One, North Taishan Road, Deyang, Sichuan, 618000, China
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Bafarat A, Alaseeri B, Labban SA, Morya RE. Oculogyric Crisis Due to Aripiprazole Ingestion as a Suicide Attempt: A Case Report. Cureus 2023; 15:e48267. [PMID: 38054149 PMCID: PMC10695413 DOI: 10.7759/cureus.48267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2023] [Indexed: 12/07/2023] Open
Abstract
Oculogyric crisis (OGC) is a rare type of acute dystonia characterized by spasmodic upward deviation of the eyes lasting for a few minutes to several hours. It is commonly seen with the administration of first-generation antipsychotics and rarely reported in patients taking second-generation antipsychotics. Although aripiprazole, a second-generation antipsychotic, is known for its low potential for extrapyramidal side effects (EPS), there are multiple case reports of it resulting in acute dystonia, especially OGC. In this paper, we report a case of aripiprazole-induced OGC in a 16-year-old female patient after a suicide attempt by taking 40 mg of aripiprazole and 5 g of acetaminophen. The necessary investigations were ordered, and the patient's dystonic symptoms resolved completely after administering parenteral diazepam and benztropine.
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Affiliation(s)
- Ammar Bafarat
- Psychiatry, Ministry of National Guard Health Affairs, Al-Ahsa, SAU
- Psychiatry, King Abdulaziz Hospital, Jeddah, SAU
| | - Badr Alaseeri
- Psychiatry, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Suhail A Labban
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Roaa E Morya
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Koul R, Maiwall R, Sarin SK, Bhatia V, Deshmukh A, Kumar C, Khajuria R, Rudra OS, Papneja S, Kantale P, Pamecha V. Unusual Facial Movements (Ictal Blinking, Oculogyric Crises, and Jaw Seizure) in Severe Liver Disease: A Case Series. J Clin Exp Hepatol 2023; 13:1149-1155. [PMID: 37975048 PMCID: PMC10643264 DOI: 10.1016/j.jceh.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/10/2023] [Indexed: 11/19/2023] Open
Abstract
Background Seizures are reported in about one-third of patients with severe liver disease in association with acute or chronic liver failure. The majority of the seizures are of focal type. Occasionally generalized tonic-clonic seizures are seen when there is ethanol withdrawal. Not much is known about ictal blinking (IB) in severe liver disease. IB is the rare form of seizures and was reported in severe liver disease recently from this institute. Oculogyric crisis (OGC) is rarely reported in relation to the severe liver disease. OGC was also noted first time in our intensive care unit. Methods At the Institute of Liver and Biliary Sciences (ILBS), data on patients with IB and OGC were analyzed from October 2018 to January 2023 (52 months). All the patients had video electroencephalograph (video-EEG) recording after proper permission/consent. The patients were followed up later for the course of the illness. Results A total of 16 (12M:4F) patients were seen. Majority 12 (75%) were IB and 3 OGC. EEG was abnormal in nine (75.0%) of IB patients. Brain imaging had nonspecific findings. The outcome was based on the severity and recovery of the underlying liver disease. Conclusions Unusual facial movements in the form of IB and OGC are reported, which are most of the time missed. This report highlights the importance of recognition of these events and proper in time management to improve the outcome.
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Affiliation(s)
- Roshan Koul
- Department of Neurology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Vikram Bhatia
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Akhil Deshmukh
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Chandan Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Rahul Khajuria
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Omkar S. Rudra
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Sangam Papneja
- Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Priyanka Kantale
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
| | - Vineyndra Pamecha
- Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, Vasant Kunj, 110070, India
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Yogi TN, Bhusal A, Limbu S, B.C. P, labh S, Kafle R. Olanzapine-induced oculogyric crisis in a patient with mania without psychotic symptoms: a case report. Ann Med Surg (Lond) 2023; 85:5255-5258. [PMID: 37811096 PMCID: PMC10553192 DOI: 10.1097/ms9.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction and importance Oculogyric crisis (OGC), marked by upward eye deviation, is rare and linked to diverse causes, including drugs and neurological conditions. This study details a 16-year-old male's OGC onset after olanzapine treatment for an initial mania episode, highlighting the need to recognize this potential side effect. Case presentation A 16-year-old male with nonpsychotic mania was treated with olanzapine and sodium valproate. On day 30, he developed OCG due to olanzapine, managed with medication. After discharge, similar ocular symptoms emerged. Gradual olanzapine tapering alongside anticholinergic administration led to symptom relief. The Young Mania Rating Scale score decreased; psychoeducation was provided to the patient and family. Discussion This study presents an exceptional case of olanzapine-induced OGC, a rare dystonic eye movement reaction. The patient's presentation matched OGC criteria, confirmed by a high Adverse Drug Reaction Probability Scale score. Unusually, symptoms appeared 30 days postolanzapine initiation. A thorough assessment ruled out alternative causes. Mechanisms, possibly related to dopamine-choline balance and receptor sensitivity, remain uncertain. Despite atypical antipsychotics' lower risk, olanzapine's moderate D2 receptor binding led to this unusual response. Management involved dose reduction and anticholinergic therapy. Conclusion This case report highlights the rare occurrence of olanzapine-induced OCG in a patient with nonpsychotic mania. Effective management requires proper history taking, examination, regular follow-up, monitoring, and appropriate medication use. The case demonstrates the need for caution when increasing olanzapine dose in manic patients with untreated mental illness and a history of neurological symptoms.
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Affiliation(s)
- Tek N. Yogi
- Department of Psychiatry, MD, BP Koirala Institute of Health Sciences (BPKIHS), Nepal
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Reinink H, Bloem BR. Sutton's law applies to functional neurology. J Neurol 2023; 270:5110-5112. [PMID: 37428203 DOI: 10.1007/s00415-023-11857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Hendrik Reinink
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
- Department of Neurology, Spaarne Gasthuis Hospital, Haarlem, The Netherlands.
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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10
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Oliveira DS, Grebe HP. Oculogyric crisis: the girl who stared at the ceiling. Pract Neurol 2023; 23:348-349. [PMID: 36914252 DOI: 10.1136/pn-2022-003653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/15/2023]
Affiliation(s)
- Daniela Santos Oliveira
- Neurology Department, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Aveiro, Portugal
| | - Hans Peter Grebe
- Neurology Department, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Aveiro, Portugal
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Cinar E, Sanci E, Utku HS, Ozbek AE. Ondansetron-induced oculogyric crisis in a pediatric patient: case report. CAN J EMERG MED 2023:10.1007/s43678-023-00517-y. [PMID: 37147446 DOI: 10.1007/s43678-023-00517-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Elif Cinar
- Department of Emergency Medicine, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Emre Sanci
- Department of Emergency Medicine, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Hatice Sinav Utku
- Department of Pediatrics, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Asim Enes Ozbek
- Department of Emergency Medicine, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
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12
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Oculogyric crisis induced by risperidone in a child with GRIN1 variant. BRAIN DISORDERS 2023. [DOI: 10.1016/j.dscb.2023.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Oculogyric Crisis after Initiation of Aripiprazole: A Case Report of an Active Duty Service Member. Case Rep Psychiatry 2023; 2023:9440028. [PMID: 36660180 PMCID: PMC9845035 DOI: 10.1155/2023/9440028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Oculogyric crisis is an acute dystonic reaction characterized by sustained, bilateral, and upward deviation of the eyes. It is a relatively uncommon extrapyramidal side effect of antipsychotic medications. Aripiprazole is an atypical antipsychotic that is FDA-approved for the treatment of schizophrenia, bipolar disorder, Tourette's disorder, and treatment resistant major depressive disorder. Compared to other antipsychotics, it is thought to have a lower propensity for causing dystonic side effects. Clinical Case. This case report is of a 19-year-old male who was psychiatrically hospitalized for first episode psychosis and initiated on low-dose oral aripiprazole. Three days after initiation of the medication, the patient was found to be markedly anxious and pacing around his room. Exam was notable for intermittent upward eye rolling, sustained upward conjugate gaze, and limited downward gaze. No other facial dyskinetic movements were observed. Treatment. The patient's oral aripiprazole was held, and he was administered 50 mg of oral diphenhydramine with improvement in symptoms within one hour. Ocular symptoms, dizziness, frontal headache, and pacing were resolved the following morning. He declined reinitiation of an antipsychotic medication. Conclusion Aripiprazole-induced acute dystonia, specifically OGC, is a rare potential adverse effect of aripiprazole. Risk factors include male gender, young age, use of typical antipsychotics, and initiation or uptitration of an antipsychotic. Even though atypical antipsychotics including aripiprazole are associated with lower risk for extrapyramidal symptoms, the possibility of oculogyric dystonia merits close monitoring especially in young, male, and drug naive patients. Anticholinergic agents such as diphenhydramine can treat symptoms of acute dystonia.
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Ismail NE, Jha AN, Goh KW, Ming LC, Wahab MSA, Shah NJ, Shah AH, Hermansyah A. Self-assumed Neurologic Related Condition Deviated Metoclopramide-Induced Acute Dystonic of Oculogyric Crisis in a Woman of Childbearing Age: A Case Report. J Pharmacol Pharmacother 2023. [DOI: 10.1177/0976500x221142377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A 26-year-old Malaysian woman (childbearing age) attended a private primary care clinic with a known case of gastroesophageal reflux disease (GERD) and complained of persistent nausea and a few episodes of vomiting. She had no known drug allergy, no surgical history, no hospitalization in the last two years, was a non-smoker, and no history of drug or alcohol abuse. The patient was prescribed Tab metoclopramide 10 mg TDS and Tab ranitidine 150 mg BD for five days. About 30 min after oral administration of both medicines, her eyes rolled involuntary upward, leading to lateral deviation of the eyes, and mouth jaws clenched as if “dislocated jaws.” The patient was immediately brought into an emergency department (ED) of a public tertiary care hospital. A drug challenge test was done which resulted in the withdrawal of metoclopramide. The accompanied sister later disclosed that the patient had taken metoclopramide and ranitidine from a private clinic earlier in the day. The patient self-assumed to have a sudden seizure, due to excessive hot weather and dehydration. A slow intravenous infusion of 50 mg/mL diphenhydramine hydrochloride in 0.9% w/v NaCl 100 mL was administered stat. Consequently, the symptoms vanished after approximately 30 min of the therapy, devoid of relapse. The patient was discharged from ED post 8 hours of monitoring with complete recovery. Physicians frequently prescribe metoclopramide to treat nausea and vomiting, which may cause adverse drug reaction of acute dystonic oculogyric crisis (OGC). Due to its unwanted and unpredictable extrapyramidal symptoms, metoclopramide should be prescribed and dispensed with caution. Thorough history taking at ED is imperative for correct early diagnosis and treatment, as metoclopramide-induced dystonic OGC has a high probability of confusion with other causes of dystonia such as conversion and seizures, encephalitis, tetanus, and hypercalcemic tetany.
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Affiliation(s)
| | - Ambika Nand Jha
- Department of Pharmacy Practice, Indubhai Patel College of Pharmacy and Research Centre, Gujarat, India
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia
| | - Long Chiau Ming
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
- School of Medical and Life Sciences, Sunway University, Sunway City, Selangor, Malaysia
| | - Mohd Shahezwan Abd. Wahab
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam Campus, Bandar Puncak Alam, Malaysia
| | - Nehal J. Shah
- Department of Pharmaceutical Chemistry, Indubhai Patel College of Pharmacy and Research Centre, Gujarat, India
| | - Akshay H. Shah
- Department of Pharmacology, Indubhai Patel College of Pharmacy and Research Centre, Gujarat, India
| | - Andi Hermansyah
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
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Sharma R, Tsikvadze M, Peel J, Howard L, Kapoor N, Freeman WD. Multimodal monitoring: practical recommendations (dos and don'ts) in challenging situations and uncertainty. Front Neurol 2023; 14:1135406. [PMID: 37206910 PMCID: PMC10188941 DOI: 10.3389/fneur.2023.1135406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/06/2023] [Indexed: 05/21/2023] Open
Abstract
With the advancements in modern medicine, new methods are being developed to monitor patients in the intensive care unit. Different modalities evaluate different aspects of the patient's physiology and clinical status. The complexity of these modalities often restricts their use to the realm of clinical research, thereby limiting their use in the real world. Understanding their salient features and their limitations can aid physicians in interpreting the concomitant information provided by multiple modalities to make informed decisions that may affect clinical care and outcomes. Here, we present a review of the commonly used methods in the neurological intensive care unit with practical recommendations for their use.
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Affiliation(s)
- Rohan Sharma
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, FL, United States
- *Correspondence: Rohan Sharma
| | - Mariam Tsikvadze
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Jeffrey Peel
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Levi Howard
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Nidhi Kapoor
- Department of Neurology, Baptist Medical Center, Jacksonville, FL, United States
| | - William D. Freeman
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, FL, United States
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ERTEKİN H, GÜMÜŞ BA. A case of metoclopramide-induced oculogyric crisis in a schizophrenic patient under anticholinergic therapy. FAMILY PRACTICE AND PALLIATIVE CARE 2022. [DOI: 10.22391/fppc.1031963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: Oculogyric crisis (OGC) is a dystonic reaction characterized as conjugate and typically upward deviation of the eyes lasting from seconds to hours which is seen as an uncommon neurologic manifestation. Metoclopramide is a prokinetic agent that is frequently prescribed in the treatment of nausea, vomiting prophylaxis, and vomiting. One of the side effects after metoclopramide treatment is acute dystonic reactions.Case Presentation: We report a case of metoclopramide-induced OGC despite the anticholinergic treatment in patient diagnosed with schizophrenia.Conclusions: Metoclopramide-induced OGC and other acute dystonic reactions may be more frequent than expected. Therefore, clinicians should monitor patients closely during treatment with metoclopramide and necessary precautions should be taken for these reactions.Keywords: Metoclopramide, oculogyric crisis, side effect, schizophrenia
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Affiliation(s)
- Hülya ERTEKİN
- Department of Psychiatry, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale
| | - Begüm Aygen GÜMÜŞ
- Department of Psychiatry, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale
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Aripiprazole-Associated Acute Dystonia During Dose Reduction in Patient With Schizophrenia and Dementia: A Case Report. J Clin Psychopharmacol 2022; 42:508-509. [PMID: 35788549 DOI: 10.1097/jcp.0000000000001581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang H, Li J, Zhou J, Dai L, Ding C, Li M, Feng W, Fang F, Ren X, Wang X. Oculogyric crisis mimicked epilepsy in a Chinese aromatic L-amino acid decarboxylase-deficiency patient: A case report. Front Neurol 2022; 13:919583. [PMID: 36119679 PMCID: PMC9481412 DOI: 10.3389/fneur.2022.919583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAromatic amino acid decarboxylase (AADC) deficiency is a rare, autosomal recessive neurometabolic disorder with heterogeneous phenotype, including hypotonia, movement disorders, autonomic dysfunction, and developmental delay. Here, we reported a Chinese patient with AADCD who was initially misdiagnosed with epilepsy.Case presentationThe proband was a 4-month-old Chinese girl, representing hypotonia, episodes of oculogyric crises with dystonia, and delayed developmental milestones. The patient was first misdiagnosed with epilepsy because of the similarity between episodes of oculogyric crisis and epileptic seizure. The accurate diagnosis of AADCD was established through analysis of neurotransmitters in cerebrospinal fluid (CSF). The genetic test confirmed the patient carried novel compound heterozygous mutations in the DDC gene:c.419G>A and c.1375C>T.ConclusionThis study reported a patient with AADCD who was initially misdiagnosed as epilepsy. Two novel missense mutations in the DDC gene were identified from the patient and her family. Little infants with epileptic-like attacks should consider AADCD. An accurate diagnosis of AADCD is essential for drug choice and patient management.
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Affiliation(s)
- Hongmei Wang
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiahong Li
- Department of Gastroenterology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ji Zhou
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Lifang Dai
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Changhong Ding
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Mo Li
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Weixing Feng
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Fang Fang
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaotun Ren
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaohui Wang
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xiaohui Wang
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Ruiz de Villa A, Haider AA, Frimer L, Bazikian Y. Oculogyric Crisis in the Setting of Low Dose Risperidone and Benztropine Mesylate Use in a Patient With Schizophrenia: A Case Report and Review of Literature. Cureus 2022; 14:e27217. [PMID: 36035042 PMCID: PMC9399662 DOI: 10.7759/cureus.27217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
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Sadnicka A, Meppelink AM, Kalinowski A, Oakeshott P, van den Dool J. Dystonia. BMJ 2022; 377:e062659. [PMID: 35410890 PMCID: PMC9070304 DOI: 10.1136/bmj-2020-062659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Sadnicka
- St George's University of London, London, UK
- University College London, London, UK
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Baizabal-Carvallo JF, Jankovic J. The clinical phenomenology and correlations of oculogyric tics. Acta Neurol Belg 2022; 122:925-930. [PMID: 35397742 DOI: 10.1007/s13760-022-01944-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oculogyric tics are identified in a substantial proportion of patients with Tourette syndrome (TS) and related tic-disorders. Nevertheless, studies assessing its frequency and clinical correlations are lacking. MATERIALS AND METHODS We reviewed video-recordings and clinical history of 201 patients with TS and chronic motor/phonic tic disorder, diagnosed according to DSM-5. RESULTS Oculogyric tics presented in 22.4% of our patients. Transient upward gaze was the most common phenomenology in patients with simple oculogyric tics; whereas eye-closure followed by upward and lateral deviations was the most commonly observed phenomenon in patients with combined oculogyric tics. Oculogyric tics have a median duration of 799 ms (range 299-34,500 ms). Patients with oculogyric tics were younger (P = 0.023) and had a higher frequency of cranial tics (P = 0.037) compared to those without oculogyric tics. No differences in tic severity, frequency of attention-deficit/hyperactivity disorder, obsessive-compulsive disorder or use of dopamine receptor antagonists were observed in patients with and without oculogyric tics. CONCLUSIONS Oculogyric tics are a common phenomenology in chronic tic disorders. They are more common in younger patients with TS and are markers of other cranial tics, but not of TS severity or comorbid neuropsychiatric syndromes.
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Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
- Department of Sciences and Engineering, University of Guanajuato, Ave León 428, Jardines del Moral, CP 37320, León, Guanajuato, Mexico.
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Williams K, Skrobanski H, Buesch K, Acaster S. Symptoms and impacts of aromatic l-amino acid decarboxylase (AADC) deficiency among individuals with different levels of motor function. Orphanet J Rare Dis 2022; 17:128. [PMID: 35313922 PMCID: PMC8935094 DOI: 10.1186/s13023-022-02274-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare neurological disorder associated with a range of symptoms and functional impairments. The aim of this study was to describe the experience of AADC deficiency across five different motor milestone health states. Methods Qualitative interviews were conducted with caregivers of individuals with AADC deficiency in Italy, Spain, Portugal and the United States. An interview guide was developed with input from clinical experts and caregivers, and explored the symptoms and impacts of AADC deficiency. Interviews were conducted by telephone and were recorded and transcribed. Data were analysed using thematic analysis and the symptoms and impacts were compared across health states.
Results Fourteen caregivers took part, who provided care to 13 individuals with AADC deficiency aged 1–15 years. Six individuals were in the ‘no motor function’ health state, one in the ‘sitting unsupported’ health state, one in the ‘standing/stepping when fully supported’ health state and five in the ‘walking with minimal support’ health state. The results highlight a substantial impact of AADC deficiency, even among those who were able to walk with minimal support. Overall, those with better motor function also had better functional hand use, communication skills, ability to eat and perform other activities independently, and interact with their peers. The burden of caring was high across all health states, but caregivers of individuals in the walking health state were better able to participate in social and leisure activities. Conclusion Individuals with higher levels of motor function had less severe symptoms and were better able to perform their daily, leisure and social activities. Treatments which improve motor function have the potential to improve other aspects of the lives of individuals with AADC deficiency and their caregivers.
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Constable PA, Al-Dasooqi D, Bruce R, Prem-Senthil M. A Review of Ocular Complications Associated with Medications Used for Anxiety, Depression, and Stress. CLINICAL OPTOMETRY 2022; 14:13-25. [PMID: 35237084 PMCID: PMC8884704 DOI: 10.2147/opto.s355091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
This review of commonly prescribed psychotropic drugs aims to update the clinician on possible ophthalmic side effects that may include dry eye, diplopia, mydriasis, and cataracts. This review summarizes our current knowledge of known ocular side effects of psychotropic drugs based on reviews, case reports, case-control studies, a case series, and cross-sectional observational studies reported in the recent literature. The review covers disorders related to depression, anxiety, and stress which are commonly encountered within society and can have debilitating impacts on an individual's quality of life that may require chronic therapeutic management. The main medications used in the treatment and management of these conditions typically target receptors, metabolic enzymes, or transport pumps that alter the pre- and/or post-synaptic levels of neurotransmitters such as serotonin, norepinephrine, dopamine, gamma-aminobutyric acid, and opioids to improve mood and/or relieve pain and anxiety. Novel non-therapeutic options are undergoing clinical trials, and some patients may seek alternative therapies or have associated substance abuse issues to alleviate their symptoms. This review summarizes some of the clinical signs of depression and the main therapeutic options and their reported ocular side effects which may be pertinent today given the rise in use of psychotropic medications used to manage depression, anxiety, and stress.
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Affiliation(s)
- Paul A Constable
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Dalia Al-Dasooqi
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Rhiannon Bruce
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Mallika Prem-Senthil
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Kassavetis P, Kaski D, Anderson T, Hallett M. Eye Movement Disorders in Movement Disorders. Mov Disord Clin Pract 2022; 9:284-295. [PMID: 35402641 PMCID: PMC8974874 DOI: 10.1002/mdc3.13413] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 11/05/2022] Open
Abstract
Oculomotor assessment is an essential element of the neurological clinical examination and is particularly important when evaluating patients with movements disorders. Most of the brain is involved in oculomotor control, and thus many neurological conditions present with oculomotor abnormalities. Each of the different classes of eye movements and their features can provide important information that can facilitate differential diagnosis. This educational review presents a clinical approach to eye movement abnormalities that are commonly seen in parkinsonism, ataxia, dystonia, myoclonus, tremor, and chorea. In parkinsonism, subtle signs such as prominent square wave jerks, impaired vertical optokinetic nystagmus, and/or the "round the houses" sign suggest early progressive supranuclear gaze palsy before vertical gaze is restricted. In ataxia, nystagmus is common, but other findings such as oculomotor apraxia, supranuclear gaze palsy, impaired fixation, or saccadic pursuit can contribute to diagnoses such as ataxia with oculomotor apraxia, Niemann-Pick type C, or ataxia telangiectasia. Opsoclonus myoclonus and oculopalatal myoclonus present with characteristic phenomenology and are usually easy to identify. The oculomotor exam is usually unremarkable in isolated dystonia, but oculogyric crisis is a medical emergency and should be recognized and treated in a timely manner. Gaze impersistence in a patient with chorea suggests Huntington's disease, but in a patient with dystonia or tremor, Wilson's disease is more likely. Finally, functional eye movements can reinforce the clinical impression of a functional movement disorder.
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Affiliation(s)
- Panagiotis Kassavetis
- National Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA,Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
| | - Diego Kaski
- Centre for Vestibular and Behavioural Neurosciences, Department of Clinical and Movement NeurosciencesUniversity College London, Institute of NeurologyLondonUK
| | - Tim Anderson
- New Zealand Brain Research InstituteChristchurchNew Zealand,Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA
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Magrinelli F, Mehta S, Di Lazzaro G, Latorre A, Edwards MJ, Balint B, Basu P, Kobylecki C, Groppa S, Hegde A, Mulroy E, Estevez-Fraga C, Arora A, Kumar H, Schneider SA, Lewis PA, Jaunmuktane Z, Revesz T, Gandhi S, Wood NW, Hardy JA, Tinazzi M, Lal V, Houlden H, Bhatia KP. Dissecting the Phenotype and Genotype of PLA2G6-Related Parkinsonism. Mov Disord 2022; 37:148-161. [PMID: 34622992 DOI: 10.1002/mds.28807] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Complex parkinsonism is the commonest phenotype in late-onset PLA2G6-associated neurodegeneration. OBJECTIVES The aim of this study was to deeply characterize phenogenotypically PLA2G6-related parkinsonism in the largest cohort ever reported. METHODS We report 14 new cases of PLA2G6-related parkinsonism and perform a systematic literature review. RESULTS PLA2G6-related parkinsonism shows a fairly distinct phenotype based on 86 cases from 68 pedigrees. Young onset (median age, 23.0 years) with parkinsonism/dystonia, gait/balance, and/or psychiatric/cognitive symptoms were common presenting features. Dystonia occurred in 69.4%, pyramidal signs in 77.2%, myoclonus in 65.2%, and cerebellar signs in 44.6% of cases. Early bladder overactivity was present in 71.9% of cases. Cognitive impairment affected 76.1% of cases and psychiatric features 87.1%, the latter being an isolated presenting feature in 20.1%. Parkinsonism was levodopa responsive but complicated by early, often severe dyskinesias. Five patients benefited from deep brain stimulation. Brain magnetic resonance imaging findings included cerebral (49.3%) and/or cerebellar (43.2%) atrophy, but mineralization was evident in only 28.1%. Presynaptic dopaminergic terminal imaging was abnormal in all where performed. Fifty-four PLA2G6 mutations have hitherto been associated with parkinsonism, including four new variants reported in this article. These are mainly nontruncating, which may explain the phenotypic heterogeneity of childhood- and late-onset PLA2G6-associated neurodegeneration. In five deceased patients, median disease duration was 13.0 years. Brain pathology in three cases showed mixed Lewy and tau pathology. CONCLUSIONS Biallelic PLA2G6 mutations cause early-onset parkinsonism associated with dystonia, pyramidal and cerebellar signs, myoclonus, and cognitive impairment. Early psychiatric manifestations and bladder overactivity are common. Cerebro/cerebellar atrophy are frequent magnetic resonance imaging features, whereas brain iron deposition is not. Early, severe dyskinesias are a tell-tale sign. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Francesca Magrinelli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sahil Mehta
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Giulia Di Lazzaro
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Mark J Edwards
- Motor Control and Movement Disorders Group, Institute of Molecular and Clinical Sciences, St George's University of London, London, United Kingdom
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Purba Basu
- Department of Neurology, Institute of Neurosciences, Kolkata, India
| | - Christopher Kobylecki
- Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Sergiu Groppa
- Department of Neurology, University Medical Center of the Johannes-Gutenberg-University of Mainz, Mainz, Germany
| | - Anaita Hegde
- Department of Paediatric Neurology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Carlos Estevez-Fraga
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Anshita Arora
- Department of Paediatric Neurology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Hrishikesh Kumar
- Department of Neurology, Institute of Neurosciences, Kolkata, India
| | - Susanne A Schneider
- Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Patrick A Lewis
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Royal Veterinary College, University of London, London, United Kingdom
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tamas Revesz
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sonia Gandhi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Nicholas W Wood
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - John A Hardy
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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Aripiprazole-Induced Oculogyric Crisis: A Pediatric Case Series and A Brief Narrative Review. CHILDREN 2021; 9:children9010022. [PMID: 35053647 PMCID: PMC8774535 DOI: 10.3390/children9010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022]
Abstract
Oculogyric crisis (OGC) represent an unusual type of dystonic movement disorder, usually reported as an adverse event of antipsychotic drugs, with acute or tardive onset, likely due to a functional disruption of dopaminergic neurotransmission. It is seldom reported in children with aripiprazole, an atypical antipsychotic commonly used in youths. In this manuscript, we report on a case series of three pediatric patients and provide a brief narrative review of the literature, in order to increase the awareness of clinicians and to foster future research in this area.
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27
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Equiza J, Rodríguez-Antigüedad J, Campo-Caballero D, Iruzubieta P, Prada Á, Roncancio A, Fernández E, Ganzarain Oyarbide M, Arruti M, Urtasun MA, Castillo-Triviño T. Autoimmune GFAP astrocytopathy presenting with remarkable CNS hyperexcitability and oculogyric crises. J Neuroimmunol 2021; 359:577695. [PMID: 34416409 DOI: 10.1016/j.jneuroim.2021.577695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
The autoimmune GFAP astrocytopathy has been associated with meningoencephalomyelitis that usually responds to glucocorticoids. We report a 20-year-old man that developed an acute and severe meningoencephalomyelitis with remarkable CNS hyperexcitability and oculogyric crises. CSF analysis showed hypoglycorrhachia, pleocytosis, elevated ADA, and CSF-immunofluorescence characteristic of autoimmune GFAP astrocytopathy. MRI showed lesions at thalamus, corpus-callosum, dorsal pons and dentate nucleus with associated myelitis. Immunotherapy led to a full recovery, although MRI activity was observed at follow-up. CNS hyperexcitability, typically seen in other immune-mediated syndromes, represents a novel presenting form to be included as part of the clinical spectrum of this entity.
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Affiliation(s)
- Jon Equiza
- Deparment of Neurology, Donostia University Hospital, Spain.
| | | | | | | | - Álvaro Prada
- Deparment of Immunology, Donostia University Hospital, Spain
| | | | - Esther Fernández
- Deparment of Magnetic Resonance, OSATEK, Donostia University Hospital, Spain
| | | | - Maialen Arruti
- Deparment of Neurology, Donostia University Hospital, Spain; Multiple Sclerosis & Demyelinating Diseases Unit, Deparment of Neurology, Donostia University Hospital, Spain
| | | | - Tamara Castillo-Triviño
- Deparment of Neurology, Donostia University Hospital, Spain; Multiple Sclerosis & Demyelinating Diseases Unit, Deparment of Neurology, Donostia University Hospital, Spain
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Skrobanski H, Williams K, Werner C, O'Neill S, Buesch K, Acaster S. The impact of caring for an individual with aromatic l-amino acid decarboxylase (AADC) deficiency: a qualitative study and the development of a conceptual model. Curr Med Res Opin 2021; 37:1821-1828. [PMID: 34259573 DOI: 10.1080/03007995.2021.1955668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare neurological condition, associated with a wide range of symptoms and functional issues, such as profound motor impairment and learning disability. Most individuals with AADC deficiency are completely dependent on their caregivers. This study explored the impact of caring for an individual with AADC deficiency. METHODS Qualitative interviews were conducted with caregivers of individuals with AADC deficiency in Italy, Portugal, Spain and the United States. An interview guide was developed with input from clinical experts and caregivers and included questions on the impact of caring for an individual with AADC deficiency. Interviews were conducted by telephone/videoconference and were recorded and transcribed. Data were analysed using thematic analysis. RESULTS Fourteen caregivers took part who provided care to 13 individuals with AADC deficiency aged 1-15 years. Caregivers reported that their lives centred around the individual with AADC deficiency, due to their need for 24-hour care and regular healthcare appointments. They reported both proximal impacts (impact on time, planning, physical health and emotional wellbeing), and distal impacts (impact on social/leisure activities, relationships, work and finances). These concepts and relationships were illustrated in a conceptual model. CONCLUSIONS This is the first qualitative study to report on the experience of caring for an individual with AADC deficiency. Caregivers reported that caring had a substantial multifaceted impact on their lives. These findings highlight the importance of considering the caregiver experience when evaluating the burden of AADC deficiency.
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Affiliation(s)
- Hanna Skrobanski
- Patient-Centred Outcomes Research, Acaster Lloyd Consulting Ltd, London, United Kingdom
| | - Kate Williams
- Patient-Centred Outcomes Research, Acaster Lloyd Consulting Ltd, London, United Kingdom
| | - Christian Werner
- Global Medical Affairs, PTC Therapeutics Germany GmbH, Frankfurt am Main, Germany
| | - Sian O'Neill
- Patient Engagement EMEA, PTC Therapeutics International Limited, Ireland
| | - Katharina Buesch
- Global Health Economics and Outcomes Research, PTC Therapeutics Switzerland GmbH, Steinhausen/Zug, Switzerland
| | - Sarah Acaster
- Patient-Centred Outcomes Research, Acaster Lloyd Consulting Ltd, London, United Kingdom
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Onuki Y, Ono S, Nakajima T, Kojima K, Taga N, Ikeda T, Kuwajima M, Kurokawa Y, Kato M, Kawai K, Osaka H, Sato T, Muramatsu SI, Yamagata T. Dopaminergic restoration of prefrontal cortico-putaminal network in gene therapy for aromatic l-amino acid decarboxylase deficiency. Brain Commun 2021; 3:fcab078. [PMID: 34423296 PMCID: PMC8374966 DOI: 10.1093/braincomms/fcab078] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 12/12/2022] Open
Abstract
Aromatic l-amino acid decarboxylase (AADC) is an essential dopamine-synthesizing enzyme. In children with AADC deficiency, the gene delivery of AADC into the putamen, which functionally interacts with cortical regions, was found to improve motor function and ameliorate dystonia. However, how the restoration of dopamine in the putamen in association with cortico-putaminal networks leads to therapeutic effects remains unclear. Here, we examined neuroimaging data of eight patients with AADC deficiency (five males and three females, age range 4-19 years) who received the AADC gene therapy of the bilateral putamen in an open-label phase 1/2 study. Using high-resolution positron emission tomography with a specific AADC tracer, 6-[18F]fluoro-l-m-tyrosine (FMT), we showed that FMT uptake increased in the broad area of the putamen over the years. Then, with the structural connectivity-based parcellation of the putaminal area, we found that motor improvement is associated with dopaminergic restoration of the putaminal area that belongs to the prefrontal cortico-putaminal network. The prefrontal area dominantly belongs to the frontoparietal control network, which contributes to cognitive-motor control function, including motor initiation and planning. The results suggest that putaminal dopamine promotes the development of an immature motor control system, particularly in the human prefrontal cortex that is primarily affected by AADC deficiency.
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Affiliation(s)
- Yoshiyuki Onuki
- Department of Neurosurgery, Jichi Medical University, Tochigi 329-0498, Japan
| | - Sayaka Ono
- Department of Neurology, Saiseikai Kurihashi Hospital, Saitama 349-1105, Japan
| | - Takeshi Nakajima
- Department of Neurosurgery, Jichi Medical University, Tochigi 329-0498, Japan
| | - Karin Kojima
- Department of Pediatrics, Jichi Medical University, Tochigi 329-0498, Japan
| | - Naoyuki Taga
- Department of Anesthesiology and Critical Care Medicine, Division of Anesthesiology, Jichi Medical University, Tochigi 329-0498, Japan
| | - Takahiro Ikeda
- Department of Pediatrics, Jichi Medical University, Tochigi 329-0498, Japan
| | - Mari Kuwajima
- Department of Pediatrics, Jichi Medical University, Tochigi 329-0498, Japan
| | - Yoshie Kurokawa
- Department of Pediatrics, Jichi Medical University, Tochigi 329-0498, Japan
| | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Tokyo 142-8666, Japan.,Department of Pediatrics, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan
| | - Kensuke Kawai
- Department of Neurosurgery, Jichi Medical University, Tochigi 329-0498, Japan
| | - Hitoshi Osaka
- Department of Pediatrics, Jichi Medical University, Tochigi 329-0498, Japan
| | | | - Shin-Ichi Muramatsu
- Division of Neurological Gene Therapy, Jichi Medical University, Tochigi 329-0498, Japan.,Center for Gene & Cell Therapy, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
| | - Takanori Yamagata
- Department of Pediatrics, Jichi Medical University, Tochigi 329-0498, Japan
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30
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Williams K, Skrobanski H, Werner C, O'Neill S, Buesch K, Acaster S. Symptoms and impact of aromatic l-amino acid decarboxylase (AADC) deficiency: a qualitative study and the development of a patient-centred conceptual model. Curr Med Res Opin 2021; 37:1353-1361. [PMID: 34042550 DOI: 10.1080/03007995.2021.1932449] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare neurological condition, with an estimated global prevalence of 1:32,000 to 1:90,000 live births. AADC deficiency is associated with a range of symptoms and functional impairments, but these have not previously been explored qualitatively. This study aimed to understand the symptoms of AADC deficiency and its impact on individuals' health-related quality of life. METHODS Qualitative interviews were conducted with caregivers of individuals with AADC deficiency in Italy, Spain, Portugal and the United States. An interview guide was developed with input from clinical experts and caregivers, and explored the symptoms and impacts of AADC deficiency. Interviews were conducted by telephone and were recorded and transcribed. Data were analysed using thematic analysis and saturation was recorded. RESULTS Fourteen caregivers took part, who provided care to 13 individuals with AADC deficiency aged 1-15 years. All individuals had impaired motor function, which was attributed to low muscle tone and muscle weakness. The level of motor function varied considerably, ranging from no motor function (no head control) to being able to take a few steps without support. Other impairments included cognitive impairment, communication difficulties, movement disorders (e.g. oculogyric crises), gastrointestinal symptoms, eating difficulties, fatigue and sleep disruption. Most individuals were completely dependent on their caregivers for all aspects of their lives. This limited function had a negative impact on their ability to socialise with their peers and on their emotional wellbeing. These concepts and relationships are illustrated in a conceptual model, and moderating factors (e.g. physiotherapy and medication) are discussed. CONCLUSION This is the first qualitative study to report on the experience of living with AADC deficiency. Caregivers report individuals with AADC deficiency experience a wide range of symptoms and functional impairments, which have a substantial impact on their health-related quality of life.
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Affiliation(s)
- Kate Williams
- Patient-Centred Outcomes Research, Acaster Lloyd Consulting Ltd, London, UK
| | - Hanna Skrobanski
- Patient-Centred Outcomes Research, Acaster Lloyd Consulting Ltd, London, UK
| | - Christian Werner
- Global Medical Affairs, PTC Therapeutics Germany GmbH, Frankfurt am Main, Germany
| | - Sian O'Neill
- Patient Engagement EMEA, PTC Therapeutics International Limited, Dublin, Ireland
| | - Katharina Buesch
- Global Health Economics and Outcomes Research, PTC Therapeutics Switzerland GmbH, Steinhausen/Zug, Switzerland
| | - Sarah Acaster
- Patient-Centred Outcomes Research, Acaster Lloyd Consulting Ltd, London, UK
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31
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Reich SG, Desai K, Agrawal S, Walzade P, Ravat S, Agarwal PA, Espay AJ. Commentary: Atypical, Early-Onset Dystonia-Parkinsonism with Oculogyric Crises and Anterior Horn Cell Disorder due to a Novel DJ-1 Mutation. Mov Disord Clin Pract 2021; 8:S19-S20. [PMID: 34514039 PMCID: PMC8414507 DOI: 10.1002/mdc3.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/30/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Stephen G. Reich
- The University of Maryland School of MedicineBaltimoreMarylandUSA
| | - Karan Desai
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
| | - Shruti Agrawal
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
| | - Priyanka Walzade
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
| | - Sangeeta Ravat
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
- Department of NeurologyGlobal HospitalsMumbaiIndia
| | - Pankaj A. Agarwal
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
- Department of NeurologyGlobal HospitalsMumbaiIndia
- Movement Disorders ClinicGlobal HospitalsMumbaiIndia
| | - Alberto J. Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of NeurologyUniversity of CincinnatiCincinnatiOhioUSA
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32
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Affiliation(s)
- Sara Boi
- From the Psychiatry department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (Boi, Rodríguez); the Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain (Boi); the Neurology department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (Garcia-Malo); and the Sleep Research Institute, Madrid, Spain (Garcia-Malo, Boi)
| | - Celia Garcia-Malo
- From the Psychiatry department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (Boi, Rodríguez); the Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain (Boi); the Neurology department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (Garcia-Malo); and the Sleep Research Institute, Madrid, Spain (Garcia-Malo, Boi)
| | - Carmen Iglesias Rodríguez
- From the Psychiatry department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (Boi, Rodríguez); the Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain (Boi); the Neurology department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (Garcia-Malo); and the Sleep Research Institute, Madrid, Spain (Garcia-Malo, Boi)
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Abstract
Acute dystonic reactions are a worrying reason for presentation to the pediatric emergency department and the pediatric neurology clinic in childhood. It must be diagnosed and treated quickly. The aim of this study was to examine the clinical presentations, etiological factors, and prognosis of patients presenting to our regional tertiary pediatric neurology clinic with a diagnosis of acute dystonic reactions in children.Nine pediatric patients who were treated for acute dystonic reactions between May, 2018 and May, 2020 and had adequate follow-up were included in the study. Medical record data were reviewed age, gender, etiology, features of family, treatment, and results.Three of the patients were female and 6 were male. Their average age was 11 years (4-17). All patients were evaluated as a drug-induced acute dystonic reaction. Of the 9 patients, 5 were due to metoclopramide, 3 were due to risperidone, and 1 was due to aripiprazole. It was learned that a similar situation against other drugs developed in the family history of 3 patients. As a treatment, all of them were intramuscularly applied biperiden suitable for their weight and 30 minutes dramatic improvement was observed. Additional dose had to be administered in only 1 case. All cases were discharged for 24 hours. No problem was observed in their follow-up.Drug-induced acute dystonic reaction can be diagnosed and has a clinical picture that completely resolves when effective treatment is applied. However, it should not be forgotten that it can reach life-threatening dimensions clinically.
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34
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Ling TK, Wong KC, Chan CY, Lau NKC, Law CY, Lee HCH, Lai CK, Chong YK, Yau KCE, Cheung KM, Ko CH, Fung CW, Lee LK, Wong SSN, Mak CM, Chan AYW, Tam S, Lam CW. Urine organic acid as the first clue towards aromatic L-amino acid decarboxylase (AADC) deficiency in a high prevalence area. Clin Chim Acta 2021; 521:40-44. [PMID: 34161777 DOI: 10.1016/j.cca.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Aromatic L-amino acid decarboxylase deficiency is a rare neurometabolic disease due to impaired decarboxylation of neurotransmitter precursors to its active form. CASE We retrospectively reviewed 8 cases from 2008 to 2019 with cerebrospinal fluid neurotransmitter analysis performed at our centre. All cases had an elevated urine vanillactic acid and, in most cases, with N-acetylvanilalanine detected. Cerebrospinal fluid analysis showed low downstream metabolites vanillylmandelic acid, homovanillic acid but high 3-O-methyl-L-DOPA, 5-hydroxytryptophan. Cerebrospinal fluid pterins were normal. Genotyping in DDC confirms the diagnosis. Urine organic acid analysis provided the first clue to diagnosis in four of the cases, which then triggered cerebrospinal fluid neurotransmitter and genetic analysis. We also developed a diagnostic decision support system to assist the interpretation of the mass spectrometry data from urine organic acids. CONCLUSIONS Urine organic acid could be essential in guiding subsequent investigations for the diagnosis of aromatic L-amino acid decarboxylase deficiency. We propose to screen suspected cases first with urine organic acids, specifically looking for vanillactic acid and N-acetylvanilalanine. Suggestive findings should be followed with target analysis for c.714 + 4A > T in ethnically Chinese patients. The assistive tool allowed expedite interpretation of profile data generated from urine organic acids analysis. It may also reduce interpreter's bias when peaks of interest are minor peaks in the spectrum.
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Affiliation(s)
- Tsz-Ki Ling
- Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Ka-Chung Wong
- Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Candace Yim Chan
- Department of Pathology, Princess Margaret Hospital, Hong Kong, China
| | | | - Chun-Yiu Law
- Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | | | - Chi-Kong Lai
- Department of Pathology, Princess Margaret Hospital, Hong Kong, China
| | - Yeow-Kuan Chong
- Department of Pathology, Princess Margaret Hospital, Hong Kong, China
| | - Kin-Cheong Eric Yau
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, China
| | - Ka-Ming Cheung
- Department of Paediatrics and Adolescent Medicine, Caritas Medical Centre, Hong Kong, China
| | - Chun-Hung Ko
- Department of Paediatrics and Adolescent Medicine, Caritas Medical Centre, Hong Kong, China
| | - Cheuk-Wing Fung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
| | - Lai-Ka Lee
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
| | - Sheila Suet-Na Wong
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
| | - Chloe M Mak
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, China
| | - Albert Yan-Wo Chan
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, China
| | - Sidney Tam
- Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Ching-Wan Lam
- Department of Pathology, Queen Mary Hospital, Hong Kong, China; Department of Pathology, The University of Hong Kong, Hong Kong, China.
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Abstract
BACKGROUND Oculogyric crisis (OGC) is a form of acute dystonia characterized by sustained dystonic, conjugate, and upward deviation of the eyes. It was initially reported in patients with postencephalitic parkinsonism. But later, other factors such as medications, movement disorders, metabolic disorders, and focal brain lesions were also found to be associated with OGC. METHODS The literature regarding OGC was searched via PubMed, Google Scholar, and through citations in relevant articles till December 2019, with keywords including OGC, oculogyric eye movements, tonic eye movement, neuroleptics and OGC, antipsychotics and OGC, and all combinations of these. Only original articles (abstract or full text) that were published in the English language were reviewed. RESULTS Hypodopaminergic state is implicated in the pathogenesis of OGC. Common risk factors are younger age, male sex, severe illness, high neuroleptic dose, parenteral administration of neuroleptics, high potency of neuroleptic drugs, abrupt discontinuation of anticholinergic medication, and family history of dystonia. CONCLUSION OGC is an acute dystonic reaction leading to tonic upward deviation of eyes. It is associated with various neurometabolic, neurodegenerative, and movement disorders and medications such as antipsychotics, antiemetics, antidepressants, antiepileptics, and antimalarials. OGC can adversely impact the compliance and prognosis of the primary illness. Hence, it needs to be managed at earlier stages with appropriate medication, primarily anticholinergics.
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Affiliation(s)
- Pankaj Mahal
- Dept. of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Navratan Suthar
- Dept. of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Naresh Nebhinani
- Dept. of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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36
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Leuzzi V, Nardecchia F, Pons R, Galosi S. Parkinsonism in children: Clinical classification and etiological spectrum. Parkinsonism Relat Disord 2020; 82:150-157. [PMID: 33109474 DOI: 10.1016/j.parkreldis.2020.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/14/2020] [Accepted: 10/03/2020] [Indexed: 01/03/2023]
Abstract
Infantile- and childhood-onset parkinsonism is mainly due to genetic alterations and is an exceedingly rare condition, unlike Parkinson's disease (PD), which is one of the most common neurologic disorders in adulthood. The clinical characterization of parkinsonism during early stages of neuromotor development is controversial due to the lack of consensus regarding the clinical criteria of PD or parkinsonism in the immature brain. The classification here proposed is based on a review of conditions that emerge during infancy and childhood, with key symptoms evocative of adult parkinsonism. The proposed nosography is based on age at presentation, clinical features, outcome, and etiological background. It includes developmental parkinsonism, infantile degenerative parkinsonism, parkinsonism in the setting of neurodevelopmental disorders, parkinsonism in the setting of multisystem brain diseases, juvenile parkinsonism and dystonia-parkinsonism, and acquired parkinsonism. The subgroups denoting peculiar clinical presentations as a consequence of disease impact on the immature brain are developmental parkinsonism due to monoamine metabolic disorders and infantile degenerative parkinsonism caused by DAT and WASR2 defects. More tardive parkinsonisms occur in genetic conditions that cause a generalized derangement of neurodevelopmental processes, such as those due to MECP2, NR4A2, SCN1A, and RAB39B. Some conditions presenting with neurodevelopmental disorder can progress later, disclosing their neurodegenerative nature (i.e. WDR45 and KCND3). Finally, new emerging conditions with childhood-onset parkinsonism arise from the cumulative effect of multiple genetic lesions.
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Affiliation(s)
- Vincenzo Leuzzi
- Department of Human Neuroscience, Sapienza University of Rome, Italy.
| | | | - Roser Pons
- First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, Agia Sophia Children's Hospital, Athens, Greece
| | - Serena Galosi
- Department of Human Neuroscience, Sapienza University of Rome, Italy
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37
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Wilson A, Filatov A, Azhar M, Swerdloff M, Husain Wilson S. Ziprasidone-Induced Oculogyric Crisis in a 74-Year-Old Female. Cureus 2020; 12:e9100. [PMID: 32789046 PMCID: PMC7417033 DOI: 10.7759/cureus.9100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Oculogyric crisis is a rare ocular dystonia first appearing at the turn of the last century in postencephalitic patients. In the modern era, they were most frequently associated with first-generation D1 dopaminergic receptor blocking antipsychotic medication. We present an unusual case of acute oculogyric crisis in a 74-year-old woman with long-standing Parkinson disease following exposure to the second-generation neuroleptic ziprasidone, which has dopaminergic (D2) and serotoninergic (5-HT2A) receptor blocking effects and is used for severe delusions and psychosis. To the best of our knowledge, there are no other published reports.
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38
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Paroxysmal oculogyric dystonia associated with a de novo 3q29 microdeletion. Psychiatr Genet 2020; 30:119-123. [PMID: 32459710 DOI: 10.1097/ypg.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
3q29 deletion syndrome is caused by a heterozygous 1.6 Mb deletion on chromosome 3, which occurs in about 1 in 30 000 births. Phenotypic features of this syndrome include mild-to-moderate intellectual disability, autism spectrum disorder, slightly dysmorphic facial features, ataxic gait, and chest-wall deformity. Gastrointestinal disorders, dental abnormalities, feeding problems during infancy, recurrent ear infections, and heart defects have also been observed. Since the incidence of the deletion is rare, the phenotype has not been fully described, particularly in adults. This report describes a young adult female with 3q29 deletion syndrome, autism spectrum disorder, intellectual disability, and anxiety who experienced a sustained, non-medication induced paroxysmal oculogyric dystonia which responded to anticholinergic and antihistaminic medications. This is the first report of paroxysmal oculogyric dystonia associated with this deletion, possibly expanding the phenotypic features of this microdeletion syndrome.
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39
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Civardi C, Collini A, Geda C. Oculogyric crisis in proton pump inhibitor-associated hypomagnesemia. Parkinsonism Relat Disord 2020; 72:80-81. [DOI: 10.1016/j.parkreldis.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/11/2020] [Accepted: 02/22/2020] [Indexed: 01/25/2023]
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40
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Hamed SA. Ocular dysfunctions and toxicities induced by antiepileptic medications: Types, pathogenic mechanisms, and treatment strategies. Expert Rev Clin Pharmacol 2019; 12:309-328. [PMID: 30840840 DOI: 10.1080/17512433.2019.1591274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Ocular dysfunctions and toxicities induced by antiepileptic drugs (AEDs) are rarely reviewed and not frequently received attention by treating physicians compared to other adverse effects (e.g. endocrinologic, cognitive and metabolic). However, some are frequent and progressive even in therapeutic concentrations or result in permanent blindness. Although some adverse effects are non-specific, others are related to the specific pharmacodynamics of the drug. Areas covered: This review was written after detailed search in PubMed, EMBASE, ISI web, SciELO, Scopus, and Cochrane Central Register databases (from 1970 to 2019). It summarized the reported ophthalmologic adverse effects of the currently available AEDs; their risks and possible pathogenic mechanisms. They include ocular motility dysfunctions, retinopathy, maculopathy, glaucoma, myopia, optic neuropathy, and impaired retinal vascular autoregulation. In general, ophthalmo-neuro- or retino-toxic adverse effects of AEDs are classified as type A (dose-dependent), type B (host-dependent or idiosyncratic) or type C which is due to the cumulative effect from long-term use. Expert opinion: Ocular adverse effects of AEDs are rarely reviewed although some are frequent or may result in permanent blindness. Increasing knowledge of their incidence and improving understanding of their risks and pathogenic mechanisms are crucial for monitoring, prevention, and management of patients' at risk.
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Affiliation(s)
- Sherifa A Hamed
- a Department of Neurology and Psychiatry , Assiut University Hospital , Assiut , Egypt
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41
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Ho SY, Chien YH, Tsai LK, Muramatsu SI, Hwu WL, Liou HH, Lee NC. Electrical Abnormalities in Dopaminergic Neurons of the Substantia Nigra in Mice With an Aromatic L-Amino Acid Decarboxylase Deficiency. Front Cell Neurosci 2019; 13:9. [PMID: 30766478 PMCID: PMC6365702 DOI: 10.3389/fncel.2019.00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/10/2019] [Indexed: 12/25/2022] Open
Abstract
Aromatic L-acid decarboxylase (AADC) deficiency causes severe motor disturbances in affected children. A putamen-targeted gene therapy improves the motor function of patients. The present study investigated the electrical properties of dopaminergic (DA) neurons in the substantia nigra compacta (SNc) of mice with an AADC deficiency (DdcKI). The basal firing of DA neurons, which determines DA release in the putamen, was abnormal in the DdcKI mice, including a low frequency and irregular firing pattern, because of a decrease in the after-hyperpolarization (AHP) amplitude of action potentials (APs). The frequency of spontaneous excitatory postsynaptic currents (sEPSCs) increased and that of spontaneous inhibitory PSCs (sIPSCs) decreased in the SNc DA neurons from the DdcKI mice, suggesting an elevation in glutamatergic excitatory stimuli and a reduction in GABAergic inhibitory stimuli, respectively. Altered expression patterns of genes encoding receptors and channels were also observed in the DdcKI mice. Administration of a widespread neuron-specific gene therapy to the brains of the DdcKI mice partially corrected these electric abnormalities. The overexcitability of SNc DA neurons in the presence of generalized dopamine deficiency likely underlies the occurrence of motor disturbances.
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Affiliation(s)
- Shih-Yin Ho
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yin-Hsiu Chien
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shin-Ichi Muramatsu
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan.,Center for Gene & Cell Therapy, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Wuh-Liang Hwu
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Horng-Huei Liou
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Neurology, National Taiwan University Hospital Yunlin Branch, Douliu, Taiwan
| | - Ni-Chung Lee
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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42
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Özdemir HN, Çelebisoy N. Oculogyric Crisis with Downward Deviation - A Photo Essay. Neuroophthalmology 2018; 42:399-401. [PMID: 30524493 PMCID: PMC6276947 DOI: 10.1080/01658107.2018.1424915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/03/2018] [Indexed: 10/17/2022] Open
Abstract
Oculogyric crisis (OGC) describes the clinical phenomenon of sustained dystonic, conjugate and typically upward deviation of the eyes. A few cases with downward or lateral deviations have been described.1,2.
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Affiliation(s)
| | - Neşe Çelebisoy
- Department of Neurology, Ege University Medical School, İzmir, Turkey
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43
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Jamal Omidi S, Fernandez BacaVaca G, Lacuey N, Shaikh AG, Morgan M, Lhatoo SD. Episodic gaze deviation in multiple sclerosis - Versive seizures or oculogyric crises? J Clin Neurosci 2018; 58:201-203. [PMID: 30327227 DOI: 10.1016/j.jocn.2018.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
Ictal gaze deviation and oculogyric crisis (OGC) can show identical clinical manifestations. We report a case of repeated drug induced OGCs in a 38 year old patient with secondary progressive multiple sclerosis. He was referred to our center for treatment of "intractable" epilepsy manifesting as episodic eye and head deviations with apparent unresponsiveness. In the epilepsy monitoring unit, ten typical spells were captured without epileptiform electroencephalographic correlates, but we discovered chronic exposure to metoclopramide. A diagnosis of OGC was suspected and Metoclopramide was stopped. This robustly improved the frequency of his spells. In a setting of usage of antidopaminergic medications and/or pontomesencephalic lesions, a low threshold should be kept for the diagnosis of oculogyric crisis, thus avoiding seizure diagnoses and inappropriate treatment of the phenomenon. Video-EEG monitoring is essential for teasing apart epilepsy and OGC.
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Affiliation(s)
- Shirin Jamal Omidi
- Epilepsy Center, Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States.
| | - Guadalupe Fernandez BacaVaca
- Epilepsy Center, Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Nuria Lacuey
- Epilepsy Center, Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Aasef G Shaikh
- Epilepsy Center, Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States; Daroff-Dell'Osso Ocular Motility Laboratory and Neurology Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH 44106, United States
| | - Michael Morgan
- Eye Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Samden D Lhatoo
- Epilepsy Center, Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
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Rohani M, Shahidi G, Vali F, Lang AE, Slow E, Gahl WA, Behnam B. Oculogyric crises in PLA2G6 associated neurodegeneration. Parkinsonism Relat Disord 2018; 52:111-112. [PMID: 29574084 DOI: 10.1016/j.parkreldis.2018.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/27/2018] [Accepted: 03/13/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Mohammad Rohani
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamali Shahidi
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Vali
- Department of Medical Genetics and Molecular Biology, Iran University of Medical Sciences, Tehran, Iran
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada
| | - Elizabeth Slow
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada
| | - William A Gahl
- Medical Genetics Branch, National Human Genome Research Institute (NHGRI), Undiagnosed Diseases Program, Common Fund, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Babak Behnam
- Department of Medical Genetics and Molecular Biology, Iran University of Medical Sciences, Tehran, Iran; Medical Genetics Branch, National Human Genome Research Institute (NHGRI), Undiagnosed Diseases Program, Common Fund, Office of the Director, National Institutes of Health, Bethesda, MD, USA.
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Affiliation(s)
- Soumitra Das
- Department of Psychiatry, National Institute of Mental Health and Neuroscience, Bengaluru, Karnataka, India
| | - Adesh Agrawal
- Department of Psychiatry, National Institute of Mental Health and Neuroscience, Bengaluru, Karnataka, India
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Solberg M, Koht J. Oculogyric Crises. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:491. [PMID: 28975049 PMCID: PMC5623758 DOI: 10.7916/d85x2n2d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/06/2017] [Indexed: 01/19/2023]
Abstract
Background Oculogyric crises are involuntary movements of the eyeballs and can occur due to different etiologies. Phenomenology Shown This video abstract shows a man with oculogyric crises due to side effect of neuroleptics. Educational Value Oculogyric crises are easy to recognize if once seen.
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Affiliation(s)
- Marianne Solberg
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Jeanette Koht
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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