Understanding Extrapyramidal Symptoms and the Medications That Cause Them
Understanding Extrapyramidal Symptoms and the Medications That Cause Them
Extrapyramidal symptoms,
also called drug-induced movement disorders, describe the side effects caused
by certain antipsychotics and other drugs.
Extrapyramidal symptoms,
also called drug-induced movement disorders, describe the side effects caused
by certain antipsychotics and other drugs. These side effects include:
-involuntary or
uncontrollable movements
-tremors
-muscle contractions
Symptoms might be severe
enough to affect daily life by making it hard to move around, communicate with
others, or take care of your usual tasks at work, school, or home.
Treatment often helps, but
some symptoms may be permanent. Generally speaking, the sooner you get
treatment, the better.
Read on to learn more
about extrapyramidal symptoms, including the medications that might cause them
and how they’re diagnosed and treated.
What are extrapyramidal symptoms?
Symptoms can occur in both
adults and children and may be severe.
Early symptoms may begin
shortly after you start a medication. They often show up a few hours after your
first dose but can show up anytime within the first few weeks.
Timing may depend on the
specific side effect. Delayed symptoms can happen after you’ve been taking the
drug for some time.
Akathisia
With akathisia, you may feel very restless or tense
and have a constant desire to move. In children, this might show up as physical
discomfort, agitation, anxiety, or general irritability. You might find that
pacing, shaking your legs, rocking on your feet, or rubbing your face helps
ease the restlessness.
Research suggests risk of
akathisia increases with higher doses of medication. Akathisia symptoms have
also been associated with a higher risk of another condition called tardive dyskinesia.
Anywhere from 5 to 36 percentTrusted Source of
people taking antipsychotics may develop akathisia.
Some medications,
including beta-blockers, may help relieve symptoms. Lowering the dose of antipsychotic
medication may also lead to improvement.
Acute dystonia
Dystonic reactions are
involuntary muscle contractions. These movements are often repetitive and might
include eye spasms or blinking, twisting head, protruding tongue, and extended
neck, among others.
Movements might be very
brief, but they could also affect your posture or stiffen your muscles for a
period of time. They most often affect your head and neck, though they can
occur in other parts of your body.
Dystonia can cause painful
muscle stiffness and other discomfort. You can also choke or have trouble
breathing if the reaction affects muscles in your throat.
Statistics suggest
anywhere between 25 and 40 percentTrusted Source of
people taking antipsychotics experience acute dystonia, though it’s more common
in children and young adults.
It usually begins within
48 hours after you start taking an antipsychotic but often improves with
treatment. Lowering the dose of antipsychotic medication can help. Dystonic
reactions may also be treated with antihistamines and drugs that treat symptoms
of Parkinson’s disease.
Parkinsonism
Parkinsonism describes
symptoms that resemble those of Parkinson’s disease. The most common symptom
is rigid muscles in your limbs. You could also have a tremor, increased
salivation, slow movement, or changes in your posture or gait.
Between 20 and 40 percentTrusted Source of
people taking antipsychotics develop Parkinsonian symptoms. They usually begin
gradually, often within a few days after you begin taking the antipsychotic.
Your dose may affect whether this side effect develops.
Symptoms vary in severity,
but they can affect movement and function. They can eventually go away on their
own in time, but they can also be treated.
Treatment generally
involves lowering the dose or trying a different antipsychotic. Drugs used to
treat symptoms of Parkinson’s disease may also be used specifically to treat
symptoms.
Neuroleptic malignant syndrome (NMS)
This reaction is rare, but
very serious.
Generally, the first signs
are rigid muscles and fever, then drowsiness or confusion. You could also
experience seizures, and your nervous system function
may be affected. Symptoms commonly appear right away, often within a few hours
after you begin taking the antipsychotic.
Research suggests no more
than 0.02 percentTrusted
Source of people will develop NMS. This condition can lead to
coma, renal failure, and death. It’s most often associated with starting an
antipsychotic, but it’s also been linked to suddenly stopping or switching
medications.
Treatment involves
stopping the antipsychotic immediately and providing supportive medical care.
With prompt medical care, full recovery is usually possible, though it may take
two weeks or longer.
Tardive dyskinesia
Tardive dyskinesia is
a late-onset extrapyramidal symptom. It involves repetitive, involuntary facial
movements, such as tongue twisting, chewing motions and lip smacking, cheek
puffing, and grimacing. You might also experience changes in gait, jerky limb
movements, or shrugging.
It usually doesn’t develop
until you’ve been taking the drug for six months or longer. Symptoms may
persist in spite of treatment. Women are more likely to have this side effect.
Age and diabetes can
increase risk, as can negative schizophrenia symptoms or
symptoms that affect typical function.
Among people taking
first-generation antipsychotics, up to about 30 percentTrusted Source may
experience this side effect.
Treatment involves
stopping the drug, lowering the dose, or switching to another drug. Clozapine,
for example, can help relieve tardive dyskinesia symptoms. Deep brain stimulation has
also shown promise as a treatment.
Subtypes of tardive dyskinesia
Tardive dystonia. This subtype is more severe than acute dystonia and
usually involves slower twisting motions across the body, such as extension of
the neck or torso.
Persistent or chronic akathisia. This refers to akathisia symptoms, such as leg movements,
arm movements, or rocking, that last for one month or longer while you’re
taking the same dose of medication.
Both of these have a later
onset and may persist in spite of treatment, but types of movement associated
with these symptoms differ.
Children who stop taking
medication suddenly may also have withdrawal dyskinesias. These jerky and
repetitive movements are generally seen in the torso, neck, and limbs. They
usually go away on their own in a few weeks, but starting the drug again and
gradually reducing the dose can also reduce symptoms.
What causes extrapyramidal symptoms?
Your extrapyramidal system
is a neural network in your brain that helps regulate motor control and
coordination. It includes the basal ganglia, a set of structures important for
motor function. The basal ganglia need dopamine for proper function.
Antipsychotics help
improve symptoms by binding to dopamine receptors in your central nervous
system and blocking dopamine. This may prevent the basal ganglia from getting
enough dopamine. Extrapyramidal symptoms can develop as a result.
First-generation antipsychotics commonly caused extrapyramidal symptoms. With second-generation antipsychotics, side effects tend to occur at lower rates. These drugs have less affinity for dopamine receptors and bind loosely and block some serotonin receptors.
First-generation antipsychotics
include:
chlorpromazine
haloperidol
levomepromazine
thioridazine
trifluoperazine
perphenazine
flupentixol
fluphenazine
Second-generation
antipsychotics include:
clozapine
risperidone
olanzapine
quetiapine
paliperidone
aripiprazole
ziprasidone
How are extrapyramidal symptoms diagnosed?
It’s important to watch
out for these symptoms if you or a loved one is taking an antipsychotic. Drug
side effects sometimes resemble the symptoms of the condition a drug is being
used to treat, but a doctor can help diagnose symptoms.
Your doctor may ask you or
a family member about your symptoms. They may be able to see difficulties
you’re having with movement or coordination during an office visit.
They might also use an
evaluation scale, such as the Drug-Induced Extrapyramidal Symptoms Scale
(DIEPSS) or the Extrapyramidal Symptoms Rating Scale (ESRS). These scales can
provide more information about your symptoms and their severity.
How are extrapyramidal symptoms treated?
Treatment for
extrapyramidal symptoms can be difficult. Drugs can have varying side effects,
and they affect people differently. There’s no way to predict the reaction you
might have.
Often the only method of
treatment is to try different drugs or lower doses to see which provide the
most relief with the fewest side effects. Depending on your symptoms, you may
also be prescribed another type of drug along with your antipsychotic to help
treat them.
You should never adjust or
change the dose of your medication without your healthcare provider’s guidance.
Changing your dose or
medication could lead to other symptoms. Note and mention any unwanted or
unpleasant side effects to your doctor.
If you’re prescribed a
lower dose of antipsychotic, tell your doctor or therapist if you begin having
symptoms of psychosis or other
symptoms your medication is meant to treat.
If you begin to
experience hallucinations,
delusions, or other distressing symptoms, get help right away. These symptoms
can increase your risk of hurting yourself or someone else, so your doctor may
want to try a different treatment approach.
It can help to talk to
your therapist if you experience distress as a result of extrapyramidal
symptoms. Therapy can’t address side effects directly, but your therapist can
offer support and ways to cope when symptoms affect your daily life or lead to
distress.
The bottom line
In some cases, extrapyramidal
symptoms may not affect you too much. In other cases, they might be painful or
uncomfortable. They can negatively affect quality of life and contribute to
frustration and distress.
If you have side effects,
you may decide to stop taking your medication to make them go away, but this
can be dangerous. If you stop taking your medication, you could experience more
serious symptoms. It’s important to keep taking your medication as prescribed
until you talk to your doctor.
If you begin to experience
any side effects while taking an antipsychotic, talk to your doctor as soon as
possible. In some cases, they can be permanent, but treatment often leads to
improvement.
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