Gözde ATAOV, Özlem Devrim BALABAN, Özlem GÜL

Treatment of tardive dystonia due to risperidone use with single-dose botulinum toxin

Late-onset dystonia occurs after long-term antipsychotic treatment or after discontinuation of treatment. Being young, male gender, mental retardation, and mood disorder are risk factors. By considering the dystonic complaints and psychotic symptoms of the patient who had a diagnosis of schizoaffective disorder and had risperidone 8 mg/day tablet use for 3 months, it was planned to continue treatment with clozapine. When the dystonic complaints did not improve, botulinum toxin was applied and recovery was achieved. In most cases, botulinum toxin can provide a dramatic improvement in the treatment of tardive dystonia, which is very difficult to treat and causes significant loss of functionality and poor quality of life. For this reason, botulinum toxin application should come to mind in the treatment of tardive dystonia.

PDF

___

1. Ozturk MO, Ulusahin NA. Mental health and disorders. Thirth ed., Ankara: Nobel Tıp Publishing, 2015. [Turkish]
2. Ozturk O, Kurt E, Oral T. Delayed-onset drug-induced movement disorders. Psychiatry Clin Psychopharmacol 2006; 16:263-273. [Turkish]
3. Jankovic J. Dopamine depleters in the treatment of hyperkinetic movement disorders. Expert Opin Pharmacother 2016; 17:2461- 2470.
4. Raja M. Managing antipsychotic-induced acute and tardive dystonia. Drug Saf 1998; 19:57-72.
5. Soykan A. An overwiew of atypical antipsychotics. J Clin Psychiatry 2000;3:13–21.
6. Tachikawa H, Suzuki T, Kawanishi Y, Hori M, Hori T, Shiraishi H. Tardive dystonia provoked by concomitantly administered risperidone. Psychiatry Clin Neurosci 2000; 54:503-505.
7. Sherr JD, Thaker G. Progression of abnormal involuntary movements during risperidone treatment. J Clin Psychiatry 1998; 59:15727.
8. Pierre JM. Extrapyramidal symptoms with atypical antipsychotics. Drug Saf 2005 28:3 2012; 28:191-208.
9. Pinninti NR, Faden J, Adityanjee A. Are second-generation antipsychotics useful in tardive dystonia? Clin Neuropharmacol 2015; 38:183-197.
10. Ryu S, Yoo JH, Kim JH, Choi JS, Baek JH, Ha K, et al. Tardive dyskinesia and tardive dystonia with second-generation antipsychotics in non-elderly schizophrenic patients unexposed to first-generation antipsychotics a cross-sectional and retrospective study. J Clin Psychopharmacol 2015; 35:13-21.
11. Greene P. Tardive dystonia. In: Yassa R, Nair NPV, Jeste DV. Neuroleptic-Induced Movement Disorders. Cambridge: Cambridge University Press, 1996:395-408.
12. Turan AB, Akkaya C, Eker SS, Sarandöl A, Karli N. Ziprasidone and tardive dystonia: A case report and literature review. Bull Clin Psychopharmacol 2016; 21:242-245.
13. Pringsheim T. Missed diagnosis of tardive dystonia in an adolescent girl treated with risperidone. 2011; 21:191-194.
14. Sienaert P, van Harten P, Rhebergen D. The psychopharmacology of catatonia, neuroleptic malignant syndrome, akathisia, tardive dyskinesia, and dystonia. Handb Clin Neurol 2019; 165:415- 428.
15. Gruber D, Trottenberg T, Kivi A, Schoenecker T, Kopp UA, Hoffmann KT, et al. Long-term effects of pallidal deep brain stimulation in tardive dystonia. Neurology 2009; 73:53-58.
16. Macerollo A, Deuschl G. Deep brain stimulation for tardive syndromes: Systematic review and meta-analysis. J Neurol Sci 2018; 389:55-60.
17. See S, Daniel V, Sanon M. Late-onset dystonia with low-dose olanzapine in an older Person: A case Report. Sr Care Pharm 2021; 36:493-500.