Olanzapine bağlı geç diskinezi: Olgu sunumu

Geç diskinezi tam bilinmeyen patofizyolojik nedenlerle oluşan, özellikle tipik antipsikotiklerle tedavinin ciddi ve yaygın bir motor yan etkisidir. Nöroleptiğe bağlı geç diskinezinin esas özellikleri antipsikotik bir ilaca maruz kalmış hastada dil, çene, gövde ve ekstremitelerde anormal, istemsiz hareketlerin oluşmasıdır. Geç diskinezinin tam patogenezi bilinmese de antipsikotiklere bağlı nigrostriatal yolaktaki dopamin süpersensitivitesinin diskinetik hareketlere yol açabileceğine dair kanıtlar vardır. Atipik antipsikotikler ile geç diskinezi riski daha az olsa da yine de geç yan etki olasılığı sürmektedir. Bazı hastalarda olanzapin geç diskinezi tedavisinde kullanılsa da, uzun süreli olanzapin kullanımının geç diskinezi/distoniye neden olduğuna ilişkin bazı olgular bildirilmiştir. Aşağıda 12 yıllık olanzapin kullanımı sonrası gelişen bir geç diskinezi olgusu ve klozapinle tedavisi açıklanmıştır.

Olanzapine and tardive dyskinesia: a case report

Tardive dyskinesia is a serious and common motor side-effect of treatment with especially traditional neuroleptics with an unknown pathophysiological basis. The essential features of neuroleptic-induced tardive dyskinesia (TD) are abnormal, involuntary movements of the tongue, jaw, trunk or extremities that emerges in a patient predisposed to antipsychotic medication. Although the exact pathogenesis of TD is unclear, there is some evidence that dopamine supersensitivity in the nigro-striatal pathway due to the antipsychotics could contribute to these dyskinetic movements. Atypical antipsychotics have less risk in terms of tardive dyskinesia compared to traditional neuroleptics however there is stil probability of late adverse effects. Although it has been suggested that olanzapine can improve tardive dyskinesia in some patients, few reported cases have shown that the prolonged use of olanzapine can instead be associated with tardive dyskinesia/dystonia. Here we report a case who experienced tardive dyskinesia after 12 years of treatment with olanzapine and its treatment with clozapine.

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