Acute Focal Dystonic Reaction After Acute Methylphenidate Treatment in an Adolescent Patient

Tekin, Uğur; Soyata, Ahmet Zihni; Oflaz, Serap

doi:10.1097/jcp.0000000000000266

Cited by 15 publications

(8 citation statements)

References 21 publications

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“…There are 10 reported cases of MPH-induced dystonia in young children not taking any other medications. 4,[6][7][8][9][10][11][12] It has been suggested that, in these cases, high levels of MPH may act as an indirect agonist by blocking the reuptake of dopamine in the striatum, prefrontal cortex, olfactory tubercle, and nucleus accumbens. In the reported cases, these high levels of dopamine are thought to be the cause of dystonia.…”

Section: Discussionmentioning

confidence: 99%

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Unprovoked Dystonic Reaction in a Child Taking Long-Term Methylphenidate

Pagliaro

Mattio

Paulson

et al. 2021

Journal of Pharmacy Practice

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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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Section: Discussionmentioning

confidence: 99%

“…Several case reports describe acute dystonia as an uncommon adverse effect of methylphenidate treatment. 4,[6][7][8][9][10] Although the pathophysiology remains unclear, the mechanism could be due to an alteration in dopamine transmission, which results in striatal acetylcholine release.…”

Section: Introductionmentioning

confidence: 99%

Unprovoked Dystonic Reaction in a Child Taking Long-Term Methylphenidate

Pagliaro

Mattio

Paulson

et al. 2021

Journal of Pharmacy Practice

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“…We focused our analysis on reports with a serious outcome because they often correlates with clinically important outcomes and include death, hospitalization or prolongation of existing hospitalization, life-threatening illness, permanent disability, birth defect, or other important medical events not resulting in the outcomes above per the US Code of Federal Regulation 16 . We limited our search to acute hyperkinetic movement disorders because both ADHD stimulants and antipsychotics are associated with drug-induced acute hyperkinetic movement disorders 17–19 . In addition, we searched PubMed and Embase on January 13, 2020, to identify any additional published case reports of acute hyperkinetic movement disorders associated with concomitant use of ADHD stimulants and antipsychotics not submitted to FAERS.…”

Section: Methodsmentioning

confidence: 99%

Acute Hyperkinetic Movement Disorders as a Multifactorial Pharmacodynamic Drug Interaction Between Methylphenidate and Risperidone in Children and Adolescents

Mohamoud

Chen²,

Croteau

et al. 2022

J Clin Psychopharmacol

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Purpose/Background: Acute hyperkinetic movement disorders have been reported with the concomitant use of attention-deficit/hyperactivity disorder (ADHD) stimulants and antipsychotics in children and adolescents. We analyzed postmarketing reports of suspected acute hyperkinetic movement disorder associated with concomitant use of ADHD stimulants and antipsychotics.Methods/Procedures: We searched for postmarketing reports of acute hyperkinetic movement disorders associated with concomitant use of ADHD stimulants-antipsychotics in the US Food and Drug Administration Adverse Event Reporting System through December 6, 2019. PubMed and EMBASE were also searched for acute hyperkinetic movement reports with the concomitant use of ADHD stimulants-antipsychotics through January 13, 2020.Findings/Results: We identified 36 cases resulting in acute hyperkinetic movement disorder associated with the concomitant use of ADHD stimulants-antipsychotics, 19 of which were also identified in the medical literature. From an ADHD stimulant perspective, methylphenidate products accounted for the largest number of cases (n = 23 [64%]), followed by amphetamine products (n = 9 [25%]) and atomoxetine (n = 4 [11%]). From an antipsychotic perspective, all 36 cases were reported with second-generation antipsychotics, particularly risperidone (n = 20 [56%]). Most of the cases were reported in boys (n = 31 [86%]) aged 6 to 12 years (n = 27 [75%]). Approximately 53% of the cases reported a time to onset within 24 hours of the drug change. Acute dystonic reactions (n = 27 [75%]) were the most frequently reported movement disorder.Implications/Conclusions: As outlined in changes to the US prescribing information for all methylphenidate and risperidone products, health care professionals should be aware that changes to this combination may be associated with a pharmacodynamic drug-drug interaction resulting in acute hyperkinetic movement disorder.

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“…In addition, ADRs have been reported after exposure to methylphenidate or other psychostimulants in children treated with (or shortly after the withdrawal of) DRBA [ 146 , 147 , 148 ], suggesting that dopaminergic drugs may increase the risk of ADRs in patients exposed to DRBA. Nevertheless, methylphenidate may cause several dyskinetic reactions, including focal dystonia, also in DRBA-naïve patients [ 149 , 150 , 151 , 152 , 153 ]. Treatment with anticholinergic drugs may be beneficial [ 141 ].…”

Section: Drug-induced and Toxic Movement Disordersmentioning

confidence: 99%

Acute Movement Disorders in Childhood

Garone

Graziola

Grasso

et al. 2021

JCM

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Acute-onset movement disorders (MDs) are an increasingly recognized neurological emergency in both adults and children. The spectrum of possible causes is wide, and diagnostic work-up is challenging. In their acute presentation, MDs may represent the prominent symptom or an important diagnostic clue in a broader constellation of neurological and extraneurological signs. The diagnostic approach relies on the definition of the overall clinical syndrome and on the recognition of the prominent MD phenomenology. The recognition of the underlying disorder is crucial since many causes are treatable. In this review, we summarize common and uncommon causes of acute-onset movement disorders, focusing on clinical presentation and appropriate diagnostic investigations. Both acquired (immune-mediated, infectious, vascular, toxic, metabolic) and genetic disorders causing acute MDs are reviewed, in order to provide a useful clinician’s guide to this expanding field of pediatric neurology.

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Acute Focal Dystonic Reaction After Acute Methylphenidate Treatment in an Adolescent Patient

Cited by 15 publications

References 21 publications

Unprovoked Dystonic Reaction in a Child Taking Long-Term Methylphenidate

Unprovoked Dystonic Reaction in a Child Taking Long-Term Methylphenidate

Acute Hyperkinetic Movement Disorders as a Multifactorial Pharmacodynamic Drug Interaction Between Methylphenidate and Risperidone in Children and Adolescents

Acute Movement Disorders in Childhood

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