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Revision as of 19:15, 22 January 2017
Extrapyramidal symptoms (EPS), also known as extrapyramidal side effects (EPSE), are drug-induced movement disorders that include acute and tardive symptoms.
These symptoms include:
- Muscle contractions - Uncontrolled and severe contractions can occur in one's head, neck, and limbs and may cause a stiff tongue, arched back, or twisted neck.
- Continuous muscle spasms
- Restlessness - This can include nervous energy such as pacing or tapping one's foot.
- Parkinsonism (characteristic symptoms such as rigidity)
- Decreased bodily movement
- Tremors
- Stiff posture - This can include the lack of arm movement when walking.
- tardive dyskinesia (irregular, jerky movements).[1]
- Uncontrolled movements of your tongue, jaw, lips, or face, such as pursing, chewing, or frequent eye blinking
- Uncontrolled movements of your fingers or toes, head nodding, or pelvic thrusting
- Fast, irregular breathing with grunts, gasping, or sighing
- Weak voice, drooling, or little or no facial expression
Causes
Extrapyramidal symptoms are most commonly caused by typical antipsychotic drugs that antagonize dopamine D2 receptors. The most common typical antipsychotics associated with EPS are haloperidol and fluphenazine.[2]
Other anti-dopaminergic drugs, like the antiemetic metoclopramide, can also result in extrapyramidal side effects.[3]
Short and long-term use of antidepressants such as selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), and norepinephrine-dopamine reuptake inhibitors (NDRI) have also resulted in extrapyramidal symptoms. Specifically, duloxetine, sertraline, escitalopram, fluoxetine, and bupropion have been linked to the induction of extrapyramidal symptoms.[4]
Treatment
Anticholinergic drugs are used to control neuroleptic-induced EPS, although akathisia may require beta blockers or even benzodiazepines. If the EPS are induced by an antipsychotic, EPS may be reduced by dose titration or by switching to an atypical antipsychotic, such as aripiprazole, ziprasidone, quetiapine, olanzapine, risperidone, or clozapine.
Commonly used medications for EPS are anticholinergic agents such as benztropine (Cogentin), diphenhydramine (Benadryl), and trihexyphenidyl (Artane). Another common course of treatment includes dopamine agonist agents such as pramipexole. These medications reverse the symptoms of extrapyramidal side effects caused by antipsychotics or other drugs that either directly or indirectly inhibit dopaminergic neurotransmission.