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Laboe C, Jain A, Cardiel Sam H. Masked Tardive Dyskinesia in the Coronavirus Disease 2019 Era. Cureus 2021; 13:e16999. [PMID: 34540401 PMCID: PMC8423327 DOI: 10.7759/cureus.16999] [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] [Accepted: 08/08/2021] [Indexed: 11/20/2022] Open
Abstract
The universal donning of masks during the coronavirus disease 2019 pandemic led to a decreased ability to read people’s facial expressions. In this context, it is prudent to think about how diagnoses can be missed or worsened by the practice of mandatory masking. Here, we report the case of an adolescent white male who presented with new-onset agitation, akathisia, and orofacial dyskinesia in the context of chronic stimulant use for the treatment of attention-deficit hyperactivity disorder and antipsychotic use for oppositional defiant disorder.
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Affiliation(s)
- Christopher Laboe
- Pyschiatry, Pennsylvania State University College of Medicine, Hershey, USA
| | - Ankit Jain
- Adult Psychiatry, Pennsylvania State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Hector Cardiel Sam
- Child and Adolescent Psychiatry, Pennsylvania State Health Milton S. Hershey Medical Center, Hershey, USA
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Pagliaro A, Mattio B, Paulson N, Fromm C, Vidal J. Unprovoked Dystonic Reaction in a Child Taking Long-Term Methylphenidate. J Pharm Pract 2021; 35:796-799. [PMID: 33813918 DOI: 10.1177/0897190021999781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this report, we discuss the case of a 9-year-old male with Attention Deficit Hyperactivity Disorder (ADHD) on long-term methylphenidate and guanfacine who experienced acute orofacial dystonia that resolved immediately with the administration of benztropine. Current literature describes various cases of methylphenidate-induced dystonia, but ours appears to be the first reported instance of spontaneous dystonia without a recent change in dose or medication change. This may suggest the possibility of methylphenidate-induced dystonia spontaneously occurring several years after initiation.
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Affiliation(s)
- Alyssa Pagliaro
- Department of Pharmacy, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
| | - Brianna Mattio
- Department of Pharmacy, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
| | - Nicholas Paulson
- Department of Pharmacy, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
| | - Christian Fromm
- Department of Emergency Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
| | - Jennifer Vidal
- Department of Pharmacy, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
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Keresztény Á, Ferenczi-Dallos G, Velő S, Gádoros J, Balázs J. Dyskinesia in Treatment-Naive and Stimulant-Treated Children With ADHD. J Atten Disord 2020; 24:981-989. [PMID: 27864427 DOI: 10.1177/1087054716679262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Stimulants are safe and effective medications for the treatment of ADHD. There are a number of case studies that report stimulant-induced dyskinesia. The aim of this study was to compare dyskinesia in a treated and a treatment-naive group of children with ADHD, and a healthy control group. Method: Children aged 6 to 18 years were involved in the study (n = 158). Diagnosis of ADHD was measured with the Mini International Neuropsychiatric Interview Kid (MINI Kid). Dyskinesia was assessed with the Abnormal Involuntary Movement Scale (AIMS). Results: Before methylphenidate administration, the treated ADHD group showed significantly higher AIMS total score than the control group (p = .001) and the treatment-naive ADHD group (p < .001). We found the same pattern 1.5 hr after methylphenidate administration. Conclusion: These results call attention that clinicians should take special care for the possible development of dyskinesia during the treatment of their ADHD patients with methylphenidate.
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Affiliation(s)
- Ágnes Keresztény
- Semmelweis University, Budapest, Hungary.,Eötvös Loránd University, Budapest, Hungary
| | | | - Szabina Velő
- Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, School of PhD Budapest, Hungary
| | - Júlia Gádoros
- Vadaskert Child Psychiatry Hospital, Budapest, Hungary
| | - Judit Balázs
- Eötvös Loránd University, Budapest, Hungary.,Vadaskert Child Psychiatry Hospital, Budapest, Hungary
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Baweja R, Mills S, Waxmonsky J. Dexmethylphenidate Extended Release-Associated Orofacial Dyskinesia in an Adolescent with Autism Spectrum Disorder After Prolonged Use. J Child Adolesc Psychopharmacol 2019; 28:423-424. [PMID: 29781724 DOI: 10.1089/cap.2018.0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Raman Baweja
- Department of Psychiatry, Penn State University College of Medicine , Hershey, Pennsylvania
| | - Sara Mills
- Department of Psychiatry, Penn State University College of Medicine , Hershey, Pennsylvania
| | - James Waxmonsky
- Department of Psychiatry, Penn State University College of Medicine , Hershey, Pennsylvania
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Methylphenidate-Associated Onychotillomania, Myoclonus, and Enuresis Reversed by Switching to Atomoxetine. Am J Ther 2019; 26:e614-e616. [DOI: 10.1097/mjt.0000000000000812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Withdrawal-Emergent Dyskinesia After Acute Discontinuation of Risperidone in a Child With Autism Spectrum Disorder. J Clin Psychopharmacol 2018; 38:640-642. [PMID: 30285999 DOI: 10.1097/jcp.0000000000000958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Effect of Biperiden Treatment in Acute Orofacial and Extremity Dyskinesia With Methylphenidate Therapy. Pediatr Emerg Care 2018; 34:e217-e218. [PMID: 28328695 DOI: 10.1097/pec.0000000000001102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Methylphenidate is a stimulant drug commonly prescribed to individuals with attention-deficit/hyperactivity disorder. The suggested underlying mechanism of acute dyskinesias is dopaminergic transmission increase. We describe a 9-year-old boy with a diagnosis of attention-deficit/hyperactivity disorder admitted to emergency clinic with primarily orofacial and extremity dyskinesia after administration of a first dose of 18 mg OROS (osmotic [controlled] release oral) methylphenidate (Concerta). OROS methylphenidate was discontinued, and the patient's symptoms resolved within 20 minutes after injection of biperiden by intravenous route (0.04 mg/kg). We wish to emphasize that acute orofacial dyskinesia and extremity dyskinesia can be observed during methylphenidate therapy and that biperiden can be successfully used in the treatment of this unpleasant condition. To the best of our knowledge, this is the first report of the use of biperiden therapy in this condition. This case report highlights the importance for physicians of awareness of dyskinesia as a potential adverse effect of methylphenidate therapy and indicates benefit of biperiden therapy.
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Kazanci SY, Tarakcioglu MC, Bulbul L, Saglam NO, Hatipoglu S. Should We Continue Methylphenidate Treatment Despite Orofacial or Extremity Dyskinesias? ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20150902042021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Selcen Yaroglu Kazanci
- Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Department of Pediatrics, Istanbul-Turkey
| | - Mahmut Cem Tarakcioglu
- Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Department of Child and Adolescent Psychiatry, Istanbul-Turkey
| | - Lida Bulbul
- Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Department of Pediatrics, Istanbul-Turkey
| | - Neslihan Ozkul Saglam
- Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Department of Pediatrics, Istanbul-Turkey
| | - Sami Hatipoglu
- Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Department of Pediatrics, Istanbul-Turkey
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Neuromotor Adverse Effects in 342 Youth During 12 Weeks of Naturalistic Treatment With 5 Second-Generation Antipsychotics. J Am Acad Child Adolesc Psychiatry 2015; 54:718-727.e3. [PMID: 26299293 PMCID: PMC10366711 DOI: 10.1016/j.jaac.2015.06.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/23/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Second-generation antipsychotic (SGA) effects in youth were monitored to quantify extrapyramidal side effects (EPS) and to identify risk profiles for treatment-emergent EPS. METHOD Data were analyzed for the nonrandomized, prospective Second-generation Antipsychotic Treatment Indications, Effectiveness and Tolerability in Youth (SATIETY) inception cohort study. EPS were assessed at baseline and 4, 8, and 12 weeks after naturalistic SGA initiation for schizophrenia, mood, disruptive behavior, and autism spectrum disorders using the Simpson-Angus Scale (SAS), Barnes Akathisia Scale, Abnormal Involuntary Movement Scale (AIMS), and Treatment Emergent Side Effect Scale. Drug-induced parkinsonism was defined by incident mean SAS score >0.33, anticholinergic initiation, or increasing total SAS score ≥2 in patients with baseline EPS. RESULTS In 342 youth aged 13.6 ± 3.5 years (male = 58.2%, antipsychotic-naive = 65.8%), 15.2% developed drug-induced parkinsonism. Raw SGA-grouped drug-induced parkinsonism rates were as follows: quetiapine = 1.5%, olanzapine = 13.8%, risperidone = 16.1%, ziprasidone = 20.0%, and aripiprazole = 27.3%. SGA type, dose, higher age, and lower baseline functioning were jointly associated with drug-induced parkinsonism (R(2) = 0.18; p < .0001). Controlling for these factors, drug-induced parkinsonism rates were significantly lower only for quetiapine and olanzapine. Subjectively reported EPS (5%), EPS-related treatment discontinuation (3.3%), and anticholinergic initiation (3%) were infrequent. Anticholinergic initiation was most frequent with risperidone (10.2%; p = .0004). Treatment-emergent dyskinesia ranged from 4.5% (aripiprazole) to 15.5% (olanzapine). SGA type, younger age, white race/ethnicity, and baseline AIMS were jointly associated with treatment-emergent dyskinesia (R(2) = 0.31; p < .0001). Controlling for these factors, treatment-emergent dyskinesia rates differed among SGA subgroups, with higher rates with olanzapine and ziprasidone. At baseline, psychostimulant use was associated with dyskinesia, and number of psychotropic comedications was associated with subjective EPS. CONCLUSION In youth, SGA-related EPS rates did not generally exceed those reported in adults, with particularly low rates with quetiapine and olanzapine.
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Snell LB, Bakshi D. Neurological adverse effects of methylphenidate may be misdiagnosed as meningoencephalitis. CASE REPORTS 2015; 2015:bcr-2014-207796. [DOI: 10.1136/bcr-2014-207796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ince E, Algedik P, Demirdogen ES, Emul M, Demir T. The Relationship between Acute Dyskinesia with a Single Dose of Methylphenidate and Recent Risperidone Discontinuation in a Child with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2015; 25:378-9. [PMID: 25920038 DOI: 10.1089/cap.2014.0148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ezgi Ince
- 1 Department of Psychiatry, Medical School of Cerrahpasa, İstanbul University , İstanbul, Turkey
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Acute focal dystonic reaction after acute methylphenidate treatment in an adolescent patient. J Clin Psychopharmacol 2015; 35:209-11. [PMID: 25607477 DOI: 10.1097/jcp.0000000000000266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim JY, Baik JS. Adult onset methylphenidate induced dyskinesia after stroke. Parkinsonism Relat Disord 2014; 20:789-91. [DOI: 10.1016/j.parkreldis.2014.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 03/19/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
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Abstract
Iatrogenic disease is one of the most frequent causes of hospital admissions and constitutes a growing public health problem. The most common type of iatrogenic neurologic disease is pharmacologic, and the central and peripheral nervous systems are particularly vulnerable. Despite this, iatrogenic disease is generally overlooked as a differential diagnosis among neurologic patients. The clinical picture of pharmacologically mediated iatrogenic neurologic disease can range from mild to fatal. Common and uncommon forms of drug toxicity are comprehensively addressed in this chapter. While the majority of neurologic adverse effects are listed and referenced in the tables, the most relevant issues are further discussed in the text.
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Affiliation(s)
- Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Osvaldo Fustinoni
- INEBA Institute of Neurosciences, Buenos Aires, Argentina; Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
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Yilmaz AE, Donmez A, Orun E, Tas T, Isik B, Sonmez FM. Methylphenidate-induced acute orofacial and extremity dyskinesia. J Child Neurol 2013; 28:781-3. [PMID: 22791547 DOI: 10.1177/0883073812449905] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Methylphenidate is a short-acting stimulant. In this article, the authors report a 7-year-old male patient who presented with orofacial and limb dyskinesia after his first dose of methylphenidate treatment for a diagnosis of attention-deficit/hyperactivity disorder; he was also receiving sodium valproate treatment for epilepsy. Orofacial dyskinesia appeared 5 hours after methylphenidate administration, persisted for 10 hours, and had completely resolved within 2 days. Although limb dyskinesia after methylphenidate is a commonly reported side effect, to the authors' knowledge this is only the second reported case to develop both orofacial and limb dyskinesia in the acute period after the first dose of methylphenidate. This case is reported to emphasize the potential side effects of methylphenidate, individual differences in drug sensitivities, and drug-receptor interactions via different mechanisms.
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Affiliation(s)
- Ayse Esra Yilmaz
- Department of Pediatrics, Faculty of Medicine, Fatih University, Ankara, Turkey
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Abstract
Ritalin® (methylphenidate) is an amphetamine-like prescription stimulant commonly used in the treatment of attention deficit hyperactivity disorder in children and adults. Recently, the recreational use of Ritalin has increased, particularly among young adults. Well-known symptoms of intoxication include signs of sympathetic nervous stimulation, such as agitation, anxiety, tachycardia, hypertension, headache, tremor, and dizziness. This case report describes oral dyskinesia as a rare presentation of Ritalin intoxication, with the review of pathophysiology and some epidemiological data.
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Abstract
Chorea is uncommonly caused by toxins. Anecdotal evidence from cases of toxin-induced chorea assists in our understanding of neurodegenerative diseases associated with chorea. Beginning in medieval Europe with ergotism and the "fire that twisted people," spanning to crack dancing in contemporary times and the coexistence of alcohol abuse with chorea, toxins may exert direct effects to enhance mesolimbic dopamine transmission or indirect effects through gamma-aminobutyric acid modulation. The following chapter will discuss toxins associated with chorea and the presumed pathophysiology underlying the movement disorders in these case series.
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Affiliation(s)
- Janis M Miyasaki
- Morton and Gloria Shulman Movement Disorders Centre, Krembil Neuroscience Centre, University Health Network, University of Toronto, Toronto, Canada.
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Balázs J, Dallos G, Keresztény A, Czobor P, Gádoros J. Methylphenidate treatment and dyskinesia in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2011; 21:133-8. [PMID: 21486166 DOI: 10.1089/cap.2010.0030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Case reports suggest a relationship between methylphenidate treatment and dyskinesia in attention-deficit/hyperactivity disorder (ADHD). The aim of the current study was (a) to investigate abnormal involuntary movements of children with ADHD before and after the administration of methylphenidate and (b) to investigate the effect of a provocative assessment method used to make latent dyskinesia visible, which is included in the Abnormal Involuntary Movement Scale (AIMS). METHODS Participants, aged 6-18, were recruited from a Child and Adolescent Psychiatric Hospital and Outpatient Clinic (Vadaskert Foundation), Budapest, Hungary. Using a structured diagnostic interview (Mini International Neuropsychiatric Interview Kid), 37 children were included in the ADHD group and 34 children in the control group. The AIMS was used to observe and score dyskinesia. RESULTS There was a significant difference between the baseline total AIMS score in the ADHD and the control groups, with the ADHD subjects evidencing substantially higher severity than controls. Provocation, as applied with the administration of the AIMS, significantly increased the AIMS total score in both groups. The administration of methylphenidate had no effect on the total score of the AIMS. In the ADHD group, we observed a significant negative relationship between the patients' age and the overall severity on the AIMS. In contrast, in the control group we detected a significant positive relationship between the patients' age and the overall severity on the AIMS before and no relationship after provocation. CONCLUSIONS Methylphenidate-treated children with ADHD had more dyskinesia than children in the control group. Dyskinesia did not worsen after a single dose of methylphenidate. Higher dyskinesia scores in the methylphenidate-treated younger age group warrant caution in the methylphenidate treatment of ADHD; however, further studies are needed to clarify the possible causal relationship between dyskinesia and methylphenidate treatment and/or age and/or the disease itself.
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Affiliation(s)
- Judit Balázs
- Vadaskert Foundation, Child and Adolescent Psychiatry Hospital and Outpatient Clinic, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.
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Mendhekar DN, Andrade C. Bruxism arising during monotherapy with methylphenidate. J Child Adolesc Psychopharmacol 2008; 18:537-8. [PMID: 18928420 DOI: 10.1089/cap.2008.18503] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - C. Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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