Successful Treatment of Neuroleptic-Induced Akathisia with Baclofen and Clonazepam

Sandyk, Reuven

doi:10.1159/000115809

Cited by 14 publications

(2 citation statements)

References 5 publications

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“…Initial evidence for the benefit of clonazepam in the treatment of drug-induced akathisia came from cases successfully treated with a combination of baclofen and clonazepam [25]. A subsequent study of ten patients with schizophrenia and akathisia showed that clonazepam could reduce the akathisia subscale of the Chouinard Extrapyramidal Symptom Rating Scale from a mean of 4 (range 3-6) to 1.6 (range 1-3) [p < 0.005] [26], as also confirmed by another open-label trial [27] and a randomized controlled trial (RCT) [28].…”

Section: Clonazepammentioning

confidence: 99%

Antiseizure Drugs and Movement Disorders

Sáenz‐Farret

Tijssen

Eliashiv³

et al. 2022

CNS Drugs

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The relationship between antiseizure drugs and movement disorders is complex and not adequately reviewed so far. Antiseizure drugs as a treatment for tremor and other entities such as myoclonus and restless leg syndrome is the most common scenario, although the scientific evidence supporting their use is variable. However, antiseizure drugs also represent a potential cause of iatrogenic movement disorders, with parkinsonism and tremor the most common disorders. Many other antiseizure drug-induced movement disorders are possible and not always correctly identified. This review was conducted by searching for all the possible combinations between 15 movement disorders (excluding ataxia) and 24 antiseizure drugs. The main objective was to describe the movement disorders treated and worsened or induced by antiseizure drugs. We also summarized the proposed mechanisms and risk factors involved in the complex interaction between antiseizure drugs and movement disorders. Antiseizure drugs mainly used to treat movement disorders are clonazepam, gabapentin, lacosamide, levetiracetam, oxcarbazepine, perampanel, phenobarbital, pregabalin, primidone, topiramate, and zonisamide. Antiseizure drugs that worsen or induce movement disorders are cenobamate, ethosuximide, felbamate, lamotrigine, phenytoin, tiagabine, and vigabatrin. Antiseizure drugs with a variable effect on movement disorders are carbamazepine and valproate while no effect on movement disorders has been reported for brivaracetam, eslicarbazepine, lacosamide, and stiripentol. Although little information is available on the adverse effects or benefits on movement disorders of newer antiseizure drugs (such as brivaracetam, cenobamate, eslicarbazepine, lacosamide, and rufinamide), the evidence collected in this review should guide the choice of antiseizure drugs in patients with concomitant epilepsy and movement disorders. Finally, these notions can lead to a better understanding of the mechanisms involved in the pathophysiology and treatments of movement disorders.

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Section: Clonazepammentioning

confidence: 99%

Antiseizure Drugs and Movement Disorders

Sáenz‐Farret

Tijssen

Eliashiv³

et al. 2022

CNS Drugs

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“…In addition to blocking dopamine D2 receptors [I I], molindone inhibits monoamine oxidase (MAO) [8] effects which could account for its antipsychotic and antidepressant properties. Such synergistic effects of clonazepam and baclofen have been found efficacious in the management of neuroleptic-induced akathisia as well [12]. However, there is evidence from both animal and clinical studies that molindone has a low propensity to induce tardive dyskinesia [I I].…”

Section: Discussionmentioning

confidence: 99%

Neuroleptic-induced “painful legs and moving toes” syndrome: successful treatment with clonazepam and baclofen

Sandyk

1990

Ital J Neuro Sci

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The syndrome of "painful legs and moving toes" is characterised by spontaneous causalgic pain in the lower extremities associated with peculiar involuntary movements of the toes and feet. It has been observed after a variety of lesions affecting the posterior nerve roots, the spinal ganglia and the peripheral nerves. The pathophysiology of the syndrome is unknown. I report a patient who developed the syndrome during treatment for schizophrenia with the antipsychotic agent molindone hydrochloride. The patient's response to the combination of clonazepam and baclofen suggests that the pathophysiology of the "painful legs and moving toes" may be linked to impairment of spinal serotonergic and GABA functions.

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Metoclopramide-induced movement disorders. Clinical findings with a review of the literature

Miller

Jankovic²

1989

Archives of Internal Medicine

101

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Successful Treatment of Neuroleptic-Induced Akathisia with Baclofen and Clonazepam

Abstract: A patient with neuroleptic-induced akathisia was successfully treated with a combination of baclofen (a GABA agonist) and clonazepam (a serotonergic agent). This suggests that agents bypassing the dopaminergic systems may be effective in the treatment of this distressing disorder.

Cited by 14 publications

References 5 publications

Antiseizure Drugs and Movement Disorders

Antiseizure Drugs and Movement Disorders

Neuroleptic-induced “painful legs and moving toes” syndrome: successful treatment with clonazepam and baclofen

Metoclopramide-induced movement disorders. Clinical findings with a review of the literature

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