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Rissardo JP, Medeiros Araujo de Matos U, Fornari Caprara AL. Gabapentin-Associated Movement Disorders: A Literature Review. MEDICINES (BASEL, SWITZERLAND) 2023; 10:52. [PMID: 37755242 PMCID: PMC10536490 DOI: 10.3390/medicines10090052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Gabapentin (GBP)-induced movement disorders (MDs) are under-recognized adverse drug reactions. They are commonly not discussed with patients, and their sudden occurrence can lead to misdiagnosis. This literature review aims to evaluate the clinical-epidemiological profile, pathological mechanisms, and management of GBP-associated MD. METHODS Two reviewers identified and assessed relevant reports in six databases without language restriction between 1990 and 2023. RESULTS A total of 99 reports of 204 individuals who developed a MD associated with GBP were identified. The MDs encountered were 135 myoclonus, 22 dyskinesias, 7 dystonia, 3 akathisia, 3 stutterings, 1 myokymia, and 1 parkinsonism. The mean and median ages were 54.54 (SD: 17.79) and 57 years (age range: 10-89), respectively. Subjects were predominantly male (53.57%). The mean and median doses of GBP when the MD occurred were 1324.66 (SD: 1117.66) and 1033 mg/daily (GBP dose range: 100-9600), respectively. The mean time from GBP-onset to GBP-associated MD was 4.58 weeks (SD: 8.08). The mean recovery time after MD treatment was 4.17 days (SD: 4.87). The MD management involved GBP discontinuation. A total of 82.5% of the individuals had a full recovery in the follow-up period. CONCLUSIONS Myoclonus (GRADE A) and dyskinesia (GRADE C) were the most common movement disorders associated with GBP.
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Zhou DJ, Pavuluri S, Snehal I, Schmidt CM, Situ-Kcomt M, Taraschenko O. Movement disorders associated with antiseizure medications: A systematic review. Epilepsy Behav 2022; 131:108693. [PMID: 35483204 PMCID: PMC9596228 DOI: 10.1016/j.yebeh.2022.108693] [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: 12/14/2021] [Revised: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022]
Abstract
New-onset movement disorders have been frequently reported in association with the use of antiseizure medications (ASMs). The frequency of specific motor manifestations and the spectrum of their semiology for various ASMs have not been well characterized. We carried out a systematic review of literature and conducted a search on CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Scopus from inception to April 2021. We compiled the data for all currently available ASMs using the conventional terminology of movement disorders. Among 5123 manuscripts identified by the search, 437 met the inclusion criteria. The largest number of reports of abnormal movements were in association with phenobarbital, valproic acid, lacosamide, and perampanel, and predominantly included tremor and ataxia. The majority of attempted interventions for all agents were discontinuation of the offending drug or dose reduction which led to the resolution of symptoms in most patients. Familiarity with the movement disorder phenomenology previously encountered in relation with specific ASMs facilitates early recognition of adverse effects and timely institution of targeted interventions.
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Affiliation(s)
- Daniel J Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Spriha Pavuluri
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Isha Snehal
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Cynthia M Schmidt
- Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, NE, United States
| | - Miguel Situ-Kcomt
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States.
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D'Abreu A, Friedman JH. Tardive Dyskinesia-like Syndrome Due to Drugs that do not Block Dopamine Receptors: Rare or Non-existent: Literature Review. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2018; 8:570. [PMID: 30191087 PMCID: PMC6125739 DOI: 10.7916/d8ff58z9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/10/2018] [Indexed: 12/01/2022]
Abstract
Background Although tardive dyskinesia (TD) is most commonly defined as a movement disorder caused by chronic exposure to dopamine‐receptor‐blocking drugs (DRBDs), it has also been thought to result from exposure to some non‐DRBDs. Methods We critiqued many reviews making the association between non‐DRBDs and a TD‐like syndrome and almost all case reports. We checked whether cases met criteria for the diagnosis of TD‐like syndrome and whether DRBDs had been excluded. Results We found that both tricyclic antidepressants and selective serotonin reuptake inhibitor antidepressants may unmask or exacerbate TD after prior exposure to or with concurrent use of DRBDs. We found support for its existence outside of this context to be extremely weak. Discussion There is little evidence that drugs other than DRBDs by themselves cause a TD syndrome; most reported cases appear to occur as a result of a “priming” effect induced by a DRBD, which is later unmasked.
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Affiliation(s)
- Anelyssa D'Abreu
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph H Friedman
- Department of Neurology, Butler Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Rohman L, Hebron A. Acute dystonic reaction caused by gabapentin. J Emerg Med 2013; 46:e89. [PMID: 24063872 DOI: 10.1016/j.jemermed.2013.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Affiliation(s)
| | - Andrew Hebron
- Accident & Emergency Department, James Cook University Hospital, Middlesbrough, UK
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Zesiewicz TA, Sullivan KL. Drug-induced hyperkinetic movement disorders by nonneuroleptic agents. HANDBOOK OF CLINICAL NEUROLOGY 2011; 100:347-63. [PMID: 21496594 DOI: 10.1016/b978-0-444-52014-2.00027-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Hyperkinetic movement disorders are characterized by excess movement, and include chorea, akathesia, asterixis, dystonia, tremor, myoclonus, and tics. A wide variety of pharmacologic agents may induce or exacerbate these disorders. Neuroleptic-induced tardive dyskinesia and levodopa-induced hyperkinesia are the most common causes of medication-induced chorea. However, several nonneuroleptic agents, including antidepressants and antiepileptic medications, may also worsen hyperkinetic movement disorders. Over-the-counter medications, such as analgesics and antiheartburn medications, have also occasionally been implicated as causing hyperkinetic movement disorders. Most information regarding drug-induced hyperkinetic disorders comes from case reports and anecdotes, rather than controlled clinical trials. Further research with larger controlled trials needs to verify many of these findings.
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Erol C, Ozben S, Ozer F, Cetin S, Tiras R. Bilateral ballism induced by gabapentin in idiopatic Parkinson's disease. Clin Neurol Neurosurg 2009; 111:397. [DOI: 10.1016/j.clineuro.2008.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 11/18/2008] [Accepted: 11/22/2008] [Indexed: 11/25/2022]
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Chorea as a side effect of gabapentin (Neurontin®) in a patient with complex regional pain syndrome Type 1. Clin Rheumatol 2007; 27:389-90. [DOI: 10.1007/s10067-007-0744-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 07/24/2007] [Accepted: 08/30/2007] [Indexed: 11/30/2022]
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Raju PM, Walker RW, Lee MA. Dyskinesia induced by gabapentin in idiopathic Parkinson's disease. Mov Disord 2007; 22:288-9. [PMID: 17089397 DOI: 10.1002/mds.21209] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
Gabapentin is an antiepileptic drug approved for the treatment of postherpetic neuralgia and as adjunctive therapy for partial seizures. The drug has been shown to be safe and nontoxic. The current literature has limited reports of neurologic toxicity associated with gabapentin therapy in patients with or without renal dysfunction. We describe the case of a 75-year-old man with renal dysfunction who developed neurologic toxicity due to gabapentin accumulation. Future studies are warranted to confirm the neurologic adverse effects of gabapentin, including any additional risks in patients with renal dysfunction.
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Affiliation(s)
- Thomas Bookwalter
- Department of Pharmaceutical Services, University of California-San Francisco, San Francisco, California 94143-0622, USA.
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Abstract
OBJECTIVE:To report a case of dystonia as an adverse effect of gabapentin.CASE SUMMARY:A 72-year-old woman was diagnosed with essential tremor and treated with propranolol 120 mg daily. The drug was withdrawn because of bradycardia, and gabapentin was prescribed 3 times a day at escalating doses to reach 2100 mg daily. The woman developed a dystonic reaction involving muscles of the neck and both arms that resolved rapidly after drug withdrawal. She was restarted on gabapentin with slow titration to 1800 mg daily, but the same dystonic reaction appeared, which led to definitive withdrawal of the drug. An objective causality assessment revealed that this adverse effect was highly probable.DISCUSSION:There have been only a few previous reports of gabapentin-induced dystonia. Other movement disorders reported with gabapentin include myoclonus, ataxia, and choreoathetosis. Gabapentin has been used to treat dystonias with variable results.CONCLUSIONS:Although gabapentin is widely used and well tolerated, it can cause dystonic reactions, which are reversible after drug withdrawal.
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Affiliation(s)
- Miguel A Pina
- Neurology Unit, Hospital Obispo Polanco de Teruel, Teruel, Spain
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French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, Theodore WH, Bazil C, Stern J, Schachter SC, Bergen D, Hirtz D, Montouris GD, Nespeca M, Gidal B, Marks WJ, Turk WR, Fischer JH, Bourgeois B, Wilner A, Faught RE, Sachdeo RC, Beydoun A, Glauser TA. Efficacy and tolerability of the new antiepileptic drugs, II: Treatment of refractory epilepsy: report of the TTA and QSS Subcommittees of the American Academy of Neurology and the American Epilepsy Society. Epilepsia 2004; 45:410-23. [PMID: 15101822 DOI: 10.1111/j.0013-9580.2004.06304.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the evidence demonstrating efficacy, tolerability, and safety of seven new antiepileptic drugs (AEDs) [gabapentin (GBP), lamotrigine (LTG), topiramate (TPM), tiagabine (TGB), oxcarbazepine (OXC), levetiracetam (LEV), and zonisamide (ZNS)] in the treatment of children and adults with refractory partial and generalized epilepsies. METHODS A 23-member committee, including general neurologists, pediatric neurologists, epileptologists, and doctors in pharmacy, evaluated the available evidence based on a structured literature review including MEDLINE, Current Contents, and Cochrane Library for relevant articles from 1987 to March 2003. RESULTS All of the new AEDs were found to be appropriate for adjunctive treatment of refractory partial seizures in adults. GBP can be effective for the treatment of mixed seizure disorders, and GBP, LTG, OXC, and TPM for the treatment of refractory partial seizures in children. Limited evidence suggests that LTG and TPM also are effective for adjunctive treatment of idiopathic generalized epilepsy in adults and children, as well as treatment of the Lennox-Gastaut syndrome. CONCLUSIONS The choice of AED depends on seizure and/or syndrome type, patient age, concomitant medications, and AED tolerability, safety, and efficacy. The results of this evidence-based assessment provide guidelines for the prescription of AEDs for patients with refractory epilepsy and identify those seizure types and syndromes for which more evidence is necessary.
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Affiliation(s)
- Jacqueline A French
- Neurological Institute, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Abstract
Anticonvulsant-induced dyskinesia (AID) is an underdiagnosed side effect of many anticonvulsants that may take place during initial or chronic treatment at normal or toxic drug levels. The occurrence of AID subjects the patient to another medical condition and may prompt an extensive work-up. Similarities with other drug-induced dyskinesias and some animal studies suggest that dopaminergic dysfunction in the basal ganglia is pivotal in the occurrence of dyskinesia. Clinical presentation and outcomes are variable; however, in most cases, dyskinesias respond well to anticonvulsant withdrawal. Enhancing the awareness of AID is important in light of the recent development of many new anticonvulsants and their wider clinical use.
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Affiliation(s)
- Megdad M Zaatreh
- University of North Carolina, Department of Neurology, 3114 Bioinformatics, CB#7025, Chapel Hill, NC 27599-7025, USA.
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Abstract
BACKGROUND Gabapentin was first approved by the FDA in 1993 as an add-on treatment for partial epileptic seizures. In May of 2002, it was approved as treatment for post-herpetic neuralgia by the Food and Drug Administration. It appears to be a promising agent in the treatment of pain, alterations of sensation and pruritus associated with dermatological disease, but no review of these uses exists. METHODS Medline and Google searches were performed for the words "Gabapentin" and "Neurontin." The articles found were reviewed. Article identified that contained references to the treatment of skin disease and neuropathic pain were examined and their contents surveyed. RESULTS Approximately 1200 articles were located in Medline that referred to Garbapentin or Neurontin. Over 150 articles reviewed its use for neuropathic pain, neuritis or neuralgia of various sorts. Approximately 20 articles reviewed its use for a variety of dermatological conditions or diseases with dermatological manifestations that included: pain control associated with wound dressing changes, erythromelagia, piloleiomyoma related pain, brachioradial pruritus, Glossodynia, vulvodynia, and reflex sympathetic dystrophy. Over 100 articles that related to Gabapentin side effects were reviewed. CONCLUSIONS Gabapentin is a very promising medication in the treatment of post-herpetic neuralgia and pain. Because dermatological patients suffer pain from painful tumors, after surgery, in conjunction with neuropathic ulcers, during dressing changes involving serious medical conditions, its applications seem manifold. Future studies must assess its role in the treatment of pruritus and other dermatological conditions involving pain or alteration of sensation.
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Affiliation(s)
- Noah Scheinfeld
- Department of Dermatology, St. Luke's Roosevelt Hospital Center, New York, NY 10025, USA.
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2002; 11:345-60. [PMID: 12138604 DOI: 10.1002/pds.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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