Oculogyric crises: A review of phenomenology, etiology, pathogenesis, and treatment

Slow, Elizabeth; Lang, Anthony E.

doi:10.1002/mds.26910

Cited by 42 publications

(40 citation statements)

References 92 publications

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“…Oculogyric crisis is a specific type of acute dystonic reaction characterized by paroxysmal, tonic ocular deviations (usually superiorly or laterally) occurring as a result of sustained contractions of the ocular muscles. 1 Episodes may last minutes to hours, typically warranting emergent intervention. Parenteral anticholinergics, including diphenhydramine and benztropine, remain the mainstay of therapy for OGC because of their rapid onset and resolution of distressing symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Oculogyric crisis (OGC) is a specific type of acute dystonic reaction characterized by paroxysmal, tonic, ocular deviations (usually superiorly or laterally) occurring as a result of sustained contractions of the ocular muscles. 1 Episodes may last minutes to hours, typically warranting emergent intervention. Oculogyric crises have been reported with antipsychotic use, particularly high-potency agents (e.g., haloperidol).…”

Section: Introductionmentioning

confidence: 99%

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Olanzapine-Induced Withdrawal Oculogyric Crisis in an Adolescent With a Neurodevelopmental Disorder

Liuzzo¹,

Stutzman²,

Murphy³

2020

The Journal of Pediatric Pharmacology and Therapeutics

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This case report describes an adolescent female with a complex psychiatric history and Fragile X syndrome who developed an antipsychotic-withdrawal emergent oculogyric crisis (OGC) in approximately 12 hours following reduction in olanzapine dose from 20 mg total daily dose to 5 mg twice daily. The team concluded that the OGC was likely related to olanzapine withdrawal based on the following clinical factors: 1) prior treatment with olanzapine 20 mg for 4 to 5 days/week for several months, without such reaction; 2) proximity of the OGC to the olanzapine dose reduction (within 12 hours); and 3) lack of recurrence with olanzapine dose increase. Additionally, her neurodevelopmental disorder and age were identified as risk factors for an acute dystonic reaction. Published case reports describe withdrawal emergent dystonia, including OGC, following abrupt discontinuation of clozapine in adults. Given structural similarities of clozapine and olanzapine it can be postulated that this phenomenon is based in muscarinic receptor function—specifically, super-sensitized muscarinic receptors may react to excessive acetylcholine upon antipsychotic discontinuation, resulting in muscle motor end plate hyperactivity. Providers caring for pediatric patients with neurodevelopmental disorders should carefully consider risks for withdrawal emergent dystonia, obtain clear medication histories, and consider slow, conservative tapers when discontinuing antipsychotics.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Olanzapine-Induced Withdrawal Oculogyric Crisis in an Adolescent With a Neurodevelopmental Disorder

Liuzzo¹,

Stutzman²,

Murphy³

2020

The Journal of Pediatric Pharmacology and Therapeutics

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“…OGC is a rare dystonia recognized as sustained upward ocular deviations that are conjugate, tonic and/or paroxysmal [3]. The condition often occurs after administration of typical antipsychotics, antiepileptics, antiemetics, antimalarials or antidepressants.…”

Section: Discussionmentioning

confidence: 99%

“…Dopamine D2 receptor blockade leads to an excess of striatal cholinergic output. This is usually dose independent and may occur at therapeutic dosages [3]. Generally, men are more frequently affected [9].…”

Section: Discussionmentioning

confidence: 99%

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Ziprasidone-Induced Oculogyric Crisis in a 74-Year-Old Female

Wilson

Filatov

Azhar

et al. 2020

Cureus

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Oculogyric crisis is a rare ocular dystonia first appearing at the turn of the last century in postencephalitic patients. In the modern era, they were most frequently associated with firstgeneration D1 dopaminergic receptor blocking antipsychotic medication. We present an unusual case of acute oculogyric crisis in a 74-year-old woman with longstanding Parkinson disease following exposure to the second-generation neuroleptic ziprasidone, which has dopaminergic (D2) and serotoninergic (5-HT2A) receptor blocking effects and is used for severe delusions and psychosis. To the best of our knowledge, there are no other published reports.

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Paroxysmal Asymmetric Dystonic Arm Posturing—A Less Recognized but Characteristic Manifestation of ATP1A3‐related disease

Balint

Stephen

Udani

et al. 2019

Movement Disord Clin Pract

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Background ATP1A3 mutations cause a wide clinical spectrum, and are one of the “commoner rare diseases”. Methods Case series of four patients with ATP1A3 mutations. Results The patients displayed characteristic episodes of dystonic arm posturing, involving a dystonic, flexed arm held in front of the body or close to the body, but with the hand raised upwards. Other attacks manifested with arm extension, either beside the body or reaching upwards. Dystonic posturing occurred paroxysmally, with no neurological signs between attacks, or combined with other signs like chorea, ataxia, and hypotonia. Conclusions While previous diagnostic criteria have not included paroxysmal or episodic dystonia, recent expert consensus has proposed to include alternating or paroxysmal dystonia as major feature calling for ATP1A3 genetic testing. Attacks of marked arm flexion posturing, either paroxysmal or as episodic exacerbation of mild pre‐existent dystonia, are a characteristic clue to ATP1A3‐related disease.

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Oculogyric crises: A review of phenomenology, etiology, pathogenesis, and treatment

Cited by 42 publications

References 92 publications

Olanzapine-Induced Withdrawal Oculogyric Crisis in an Adolescent With a Neurodevelopmental Disorder

Olanzapine-Induced Withdrawal Oculogyric Crisis in an Adolescent With a Neurodevelopmental Disorder

Ziprasidone-Induced Oculogyric Crisis in a 74-Year-Old Female

Paroxysmal Asymmetric Dystonic Arm Posturing—A Less Recognized but Characteristic Manifestation of ATP1A3‐related disease

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