Table 1
Comparison of different groups of drugs causing drug-induced movement disorder.
| Characteristics | DRBA (N = 30) | Non-DRBA (N = 37) | DRBA + Non-DRBA (N = 30) | p-value |
|---|---|---|---|---|
| Mean age (in years) ± SD | 34 ± 18 | 28 ± 18 | 33.7 ± 16.8 | .501 |
| Frequency of different DIMD^# | ||||
| DIP | 16 (53.3%) | 5 (13.5%) | 11(36.7%) | .0017 |
| Tardive dystonia | 11 (36.6%) | 13 (35.1%) | 17 (56.7%) | .156 |
| Tardive dyskinesia | 10 (33.3%) | 7 (18.9%) | 4 (13.3%) | .150 |
| Postural tremors | 5 (16.6%) | 20 (54%) | 12 (40%) | .007 |
| Acute dystonia | 6 (18.2%) | 3 (8.1%) | 1 (3.3%) | .089 |
| NMS | 1 (3%) | 0 | 1 (3.3%) | – |
| Others* | 5 (16.6%) | 4 (10.8%) | 1 (3.3%) | – |
[i] ^ DIMDs are classified as per DSM-5 criteria.
# Total ≠ 100%, as some patients had more than one type of DIMD.
* Others include chorea (n = 3), acute dyskinesia (n = 2), stereotypy (n = 3), myoclonic jerks (n = 1) and acute akathisia (n = 1).
Abbreviations: DIMD – drug-induced movement disorders, DIP – drug induced parkinsonism, DRBA – dopamine receptor blocking agents, NMS – neuroleptic malignant syndrome.
Table 2
Age distribution of different drug induced movement disorders.
| Age (In years) | Tardive dystonia N = 41 | Postural Tremor N = 38 | DIP N = 32 | Tardive dyskinesia N = 21 | Acute dystonia N = 10 | Others* N = 10 | NMS N = 2 |
|---|---|---|---|---|---|---|---|
| 0–<10 | 0 | 0 | 1 | 1 | 0 | 0 | 0 |
| 10–<20 | 7 | 3 | 2 | 4 | 3 | 3 | 0 |
| 20–<30 | 12 | 16 | 7 | 2 | 2 | 2 | 0 |
| 30–<40 | 6 | 10 | 6 | 0 | 4 | 2 | 0 |
| 40–<50 | 4 | 5 | 3 | 3 | 0 | 1 | 0 |
| 50–<60 | 5 | 2 | 7 | 5 | 0 | 0 | 1 |
| 60–<70 | 5 | 2 | 2 | 3 | 0 | 1 | 0 |
| ≥70 | 2 | 0 | 4 | 3 | 1 | 1 | 1 |
| Pearson correlation coefficient (r) | 0.055 | –0.53 | 0.189 | 0.203 | –0.112 | 0.039 | # |
| P-value | 0.586 | 0.125 | 0.058 | 0.041 | 0.263 | 0.695 | # |
[i] Abbreviations: DIP – drug induced parkinsonism, NMS – neuroleptic malignant syndrome.
* Others include chorea (n = 3), acute dyskinesia (n = 2), stereotypy (n = 3), myoclonic jerks (n = 1) and acute akathisia (n = 1).
# Small sample size.
Videos
Phenomenology of drug induced movement disorders
Case 1. A 15-year-old boy developed parkinsonism after taking tablets of risperidone for 15 days. He also has truncal dystonia to the left and dystonic head tremor.
Case 2. A 70-year-old female developed oro-lingual stereotyped tardive dyskinesia while on escitalopram for one year. There is also jaw dyskinesia in addition to lingual and labial dyskinesia.
Case 3. A 12-year old girl developed acute jaw opening dystonia and oculogyric crisis after taking a single dose of tablet haloperidol (5mg).
Case 4. A 65-year-old male developed stereotypy and respiratory dyskinesia while on tablet risperidone for 5 months.
Case 5. A 43-year-old male who was a known case of hiatal hernia developed lingual dystonia while taking levosulpiride for one month for dyspepsia.
Case 6. A 63-year-old male developed perioral and tongue dyskinesia, bruxism, and right upper and lower limbs stereotypy while on tablet haloperidol for 6 months for his psychiatric symptoms.
Case 7. A 30-year-old man developed oculogyric crises on treatment with risperidone for 2 days.
Case 8. A 60-year-old female developed acute onset akathisia after intramuscular injection of haloperidol (2 mg). There is also unusual posturing in the right hand.
Figure 1
The most common movement disorders observed in different groups of drugs.
DRBA: dopamine receptor blocking agents; Non-DRBA: Non-dopamine receptor blocking agents.
Table 3
Pharmacotherapy regimen characteristics of patients who developed drug-induced movement disorders while taking anti-psychotics.
| Characteristic | Description (N = 49) | |
|---|---|---|
| Agents# | ||
| First generation agent (FGA): | Haloperidol | 14 (28.6%) |
| Trifluoperazine Chlorpromazine | 5 (10.2%) 4 (8.2%) | |
| Fluphenazine | 1 (2.04%) | |
| Second generation agent (SGA): | Risperidone | 29 (59.2%) |
| Olanzapine | 8 (16.3%) | |
| Aripiprazole | 5 (10.2%) | |
| Amisulpride | 3 (6.1%) | |
| Quetiapine | 3 (6.1%) | |
| Clozapine | 2 (4.1%) | |
| Classification | FGA | 9 (18.4%) |
| SGA | 26 (53.1%) | |
| FGA+SGA | 14 (28.6%) | |
| Total no. of agents | 1 | 31 (63.3%) |
| 2 | 12 (24.5%) | |
| ≥3 | 6 (12.2%) | |
| Duration of exposure of neuroleptics before DIMD onset | <1 week | 6 (12.2%) |
| 1 week–<1month | 3 (6.1%) | |
| 1month–<6month | 10 (20.4%) | |
| 6 months–<1year | 4 (8.2%) | |
| 1–<2 year | 1 (2.04%) | |
| ≥2 year | 14 (28.6%) | |
| unknown | 11 (22.4%) | |
[i] # Total ≠ 100%, as some patients were taking multiple agents.
Abbreviations: FGA – first-generation antipsychotics, SGA – second-generation antipsychotics, DIMD – drug-induced movement disorder.
Table 4
Details of patients with prokinetics induced movement disorders.
| S No | Prokinetic agent | Sex | Age | Duration in months | DIP | Acute Dystonia | Tardive dyskinesia | Tardive dystonia | Postural tremor |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Levosulpride | F | 70 | 1 month | + | – | + | – | – |
| 2 | Levosulpride | F | 70 | 2 months | + | + | – | – | – |
| 3 | Levosulpride | M | 43 | 1 month | – | + | – | – | – |
| 4 | Levosulpride | F | 42 | 4 years | – | – | + | – | + |
| 5 | Levosulpride | F | 50 | 2.5 year | – | – | + | + | + |
| Levosulpride | F | 59 | 6 months | – | – | + | – | – | |
| 7 | Levosulpride | F | 60 | 9 months | + | – | – | + | – |
| 8 | Itopride | M | 41 | 1 month | – | – | – | + | – |
| 9 | Itopride | F | 38 | 15 days | + | + | – | – | – |
| 10 | Domperidone | F | 26 | 1 week | – | + | – | – | – |
| 11 | Domperidone | M | 22 | 1 month | – | – | – | + | + |
| 12 | Metoclopramide | M | 55 | 8 months | – | – | + | – | + |
| 13 | Metoclopramide | M | 76 | 3 months | – | – | + | – | – |
[i] Abbreviations: DIP – drug induced parkinsonism, NA – not available.
Table 5
Pharmacotherapy regimen characteristics of patients with anti-epileptic induced movement disorders.
| Characteristics | Detailed description (N = 31) | |
|---|---|---|
| Different subgroups of drugs taken | Only antiepileptic (without DRBAs) With DRBAs | 17 (55%) 14 (45%) |
| Total number of antiepileptic agents | Monotherapy Polytherapy | 24 (77%) 7 (22%) |
| Agents | Valproate | 25 (80%) |
| Phenytoin | 7 (22%) | |
| Levetiracetam | 4 (13%) | |
| Clobazam | 2 (6%) | |
| Carbamazepine | 1 (3%) | |
| Oxcarbamazepine | 1 (3%) | |
| Type of DIMD@ | Postural tremor | 19 (61.3%) |
| Tardive dystonia | 11 (35.5%) | |
| DIP | 6 (19.3%) | |
| Tardive dyskinesia | 4 (13%) | |
| Acute perioral tongue and palatal dyskinesia# | 1 (3%) | |
| Chorea* | 1 (3%) | |
[i] @Total ≠ 100%, as some patients had more than one type of DIMD.
# Phenytoin induced.
* Valproate induced.
DIP – drug induced parkinsonism, DRBA – dopamine receptor blocking agents, DIMD – drug-induced movement disorder.