Acute dystonia induced by midazolam and abolished by flumazenil.

Eye rolling as a manifestation of clobazam toxicity in a child with epilepsy

“…The association with back arching raises the possibility of an extrapyramidal movement disorder. Benzodiazepines have rarely been reported to induce acute dystonia, although this has not specifically been reported for clobazam (Rosenbaum andde la Fuente 1979, Stolarek andFord 1990). Eye rolling has not previously been reported as a manifestation of clobazam toxicity in children.…”

Adverse Drug Reaction: Midazolam-Induced Extrapyramidal Symptoms: A Case Report

“…9 Rarely, midazolam can also elicit paradoxical disinhibition 9,10 and dyskinetic motor disturbances. [1][2][3][4][5][6][7][8] Published data describing midazolam-induced dyskinetic reactions are limited to a small cohort of case studies, including acute dystonia in a 6-year-old girl receiving sedation with midazolam before removal of a foreign body, 2 EPS in an 82-year-old man receiving subcutaneous midazolam in a palliative care setting, 3 athetoid movements of the lower extremities in 2 geriatric patients premedicated with midazolam before epidural anesthesia, 4 dystonic reaction to IV midazolam in a 14-year-old boy before endoscopy, 5 and dyskinesias in a 58-year-old woman who received midazolam for epidural anesthesia. 6 In each of the above cases, the unexpected motor disturbances were reversible and terminated either by cessation of midazolam itself or by administering alternate medications (antagonists such as flumazenil and physostigmine or alternate sedatives including propofol and, paradoxically, diazepam).…”

“…Although midazolam is near ubiquitous in the perioperative and periprocedural environment due to its relative safety and predictability, rare untoward reactions following midazolam administration have been encountered and described, including paradoxic excitatory responses (anxiety, agitation, hostility) and unexpected motor disturbances (dystonia, dyskinesia, tremor, athetoid movements). [1][2][3][4][5][6][7][8][9][10] We report a case in which midazolam administration before a regional nerve block procedure resulted in the acute onset of dyskinetic extrapyramidal side effects, which terminated immediately on reversal with the benzodiazepine antagonist flumazenil. Written authorization patient consent was obtained for this case report.…”

Midazolam-induced acute dystonia reversed by diazepam

“…[ 3 – 5 ] There is limited data about the extrapyramidal side effects of midazolam in the literature. [ 4 – 7 ] Acute dystonic reaction following IV sedation with midazolam, prior to upper gastrointestinal endoscopy, has been reported in an 14-year-old boy. [ 4 ] Extrapyramidal side effects following the subcutaneous injection of midazolam has been reported in an 82-year-old man.…”

“…[ 4 – 7 ] Acute dystonic reaction following IV sedation with midazolam, prior to upper gastrointestinal endoscopy, has been reported in an 14-year-old boy. [ 4 ] Extrapyramidal side effects following the subcutaneous injection of midazolam has been reported in an 82-year-old man. [ 5 ] In both the cases, during the dystonic reactions, the patient remained alert and oriented but in an opisthotonus posture and there were dystonic contractions in lower and upper extremities.…”