Tardive dystonia (TDt) is one of the extrapyramidal syndromes caused primarily by long-term use of dopamine receptor antagonists such as antipsychotics. Although the risperidone-induced TDt cases have been reported in adults, there are few case reports and clinical anecdotes in children. The first step in treatment is the controlled withdrawal of the drug causing the TDt and, if necessary, a transition to a newer “atypical” antipsychotic class. In this article, we present a case of risperidone-induced tardive dystonia and the efficacy of aripiprazole in a 10-years-old boy with moderate mental retardation and conduct disorder referred to us due to restlessness, aggression, self-mutilation, and leg and hip spasms. The child’s dystonic symptoms and challenging behaviors almost fully recovered 3 months of after the aripiprazole administration. Given that the long-term use of antipsychotics in children is increasingly widespread, TDt should be evaluated and monitored periodically. Furthermore, aripiprazole may be a suitable substitute in the TDt treatment in children.
1. van Harten PN, Kahn RS. Tardive dystonia. Schizophr Bull 1999; 25:741-748.
2. Giménez-Roldán S, Mateo D, Bartolomé P. Tardive dystonia and severe tardive dyskinesia. A comparison of risk factors and prognosis. Acta Psychiatr Scand 1985; 71:488-494.
3. Savitt D, Jankovic J. Tardive syndromes. J Neurol Sci 2018; 389:35-42.
4. Pringsheim T. Missed diagnosis of tardive dystonia in an adolescent girl treated with risperidone. J Child Adolesc Psychopharmacol 2011; 21:191-194.
5. Munetz MR, Benjamin S. How to examine patients using the Abnormal Involuntary Movement Scale. Hosp Community Psychiatry 1988; 39:1172-1177.
6. Thyssen A, Vermeulen A, Fuseau E, Fabre MA, Mannaert E. Population pharmacokinetics of oral risperidone in children, adolescents and adults with psychiatric disorders. Clin Pharmacokinet 2010; 49:465-478.
7. Correll CU, Kane JM. One-year incidence rates of tardive dyskinesia in children and adolescents treated with second-generation antipsychotics: a systematic review. J Child Adolesc Psychopharmacol 2007; 17:647-656.
8. Aggarwal A, Jiloha RC. Olanzapine induced tardive dystonia. Indian J Pharmacol 2008; 40:237-238.9. Rauchverger B, Isakov V, Jabarin M. Olanzapine-induced tardive dystonia successfully treated by tetrabenazine. J Neuropsychiatry Clin Neurosci 2007; 19:484-485.
10. Fdhil H, Krebs MO, Bayle F, Vanelle JM, Olie JP. Risperidone-induced tardive dystonia: a case of torticollis. Encephale 1998; 24:581-583. (French)
11. Oommen E, Chand PK, Sharma PS. Aripiprazole-induced tardive dystonia. Prim Care Companion J Clin Psychiatry 2006; 8:378-379.
12. Joe S, Park J, Lim J, Park C, Ahn J. Remission of irreversible aripiprazole-induced tardive dystonia with clozapine: a case report. BMC Psychiatry 2015; 15:253.
13. Matsuda N, Hashimoto N, Kusumi I, Ito K, Koyama T. Tardive laryngeal dystonia associated with aripiprazole monotherapy. J Clin Psychopharmacol 2012; 32:297-298.
14. Lamberti M, Di Rosa G, Cucinotta F, Pironti E, Galati C, Gagliano A. Aripiprazole-induced Tardive Dyskinesia in 13 Years Old Girl Successfully Treated with Biperiden: A Case Report. Clin Psychopharmacol Neurosci 2017; 15:285-287.
15. Tomruk NB, Saatcioglu O, Yildizhan E, Alpay N. Aripiprazole-induced tardive dyskinesia treated with quetiapine: a case report. Acta Neuropsychiatr 2011; 23:188-190.
16. Tibrewal P, Zutshi A, Math SB. Tardive dystonia and ziprasidone: a case report. Prim Care Companion J Clin Psychiatry 2008; 10:71-72.
17. Gourzis P, Skokou M, Soubasi E, Katrivanou A, Polychronopoulos P. Treatment of tardive dystonia induced by antipsychotics, old and new. Clin Neuropharmacol 2015; 38:121-126.
18. Di Sciascio G, Riva MA. Aripiprazole: from pharmacological profile to clinical use. Neuropsychiatr Dis Treat 2015; 11:2635-2647.
19. Huh L, Lee BJ. Efficacy of aripiprazole in antidepressants-induced tardive dystonia and tardive dyskinesia: a case report. Psychiatr Danub 2015; 27:195-197.
20. Kang NR, Kim MD. Tardive dyskinesia: treatment with aripiprazole. Clin Psychopharmacol Neurosci 2011; 9:1-8.
21. Rachamallu V, Elberson BW, Vutam E, Aligeti M. Off-label use of clozapine in children and adolescents-a literature review. Am J Ther 2019; 26:e406-e416.