Methylphenidate Induced Acute Dystonic Reaction

Unprovoked Dystonic Reaction in a Child Taking Long-Term Methylphenidate

“…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.…”

“…Review of the literature reveals MPH dystonic reactions treated variously with carbamazepine, biperiden, diazepam, diphenhydramine, and benztropine. 4,6,7,9,10,11,14,15 Four cases resolved without pharmacologic intervention, and 2 cases resolved by restarting MPH or risperidone, respectively, after it was hypothesized that their discontinuation was the cause of the dystonic reaction. In our case, 1.5 mg of intramuscular benztropine achieved complete and immediate resolution of symptoms.…”

“…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.…”

Tardive and Acute Dystonic Reactions Probably Related to Extended Release Methylphenidate in an Early Adolescent with ADHD

“…in addition to stimulants. [3][4][5] Here, tardive dystonic reaction in an early adolescent patient with ADHD probably related with MPH and its management was reported.…”

“…[2][3][4] Recently, cases of dystonia among children receiving MPH treatment have been reported. [3][4][5] Dystonia in those cases may be either acute or chronic and the majority of the patients were also using other agents (e.g., antipsychotics alfa-2 adrenergic blockers etc.) in addition to stimulants.…”