Extra-Pyramidal Symptoms (medication Induced)

Etiology

  • Related to use of typical and atypical antipsychotics
  • Induces parkinson-like and other movement-related features

Symptoms

  • Can be acute (within hours/days of med use) or chronic
  • Patients are typically cooperative and interactive
  • Tremor, rigidity, diminished movement
  • Acute dystonias (movements), akithisia (inability to sit still)
  • Acute parkinsonism (below)
  • Chronic symptoms (Tardive Dyskinesia) present after longer exposure to meds: include dystonias, akithisia

Physical Exam Findings

  • Acute dystonia: twisting and repetitive movements or postures; often painful; most common in head/neck area: torticollis--> neck flexed backward and laterally, oculogyric crisis (sustained upward deviation of eyes), blepharospasm, open mouth w/protruding tongue; can also affect arms, legs; akathisia (inability to sit still)
  • Acute Parkisonism: bradykinesia, tremor, rigidity, postural instability
  • Chronic med induced dystonias: repetitive oral/facial movements; lip smacking; repetitive hand waving, arm/leg movements, body rocking; repetitive vocalization (e.g. humming, moaning); often improve w/voluntary action