Extrapyramidal symptoms, also called drug-induced movement disorders, describe side effects caused by certain antipsychotics and certain drugs. These side effects include:
• Involuntary or uncontrolled movements
• Muscle contractions
Symptoms; it may be severe enough to affect daily life, making it difficult to walk around, communicate with others, or perform the usual tasks at work, school or home. Treatment usually helps, but some symptoms can be permanent and the sooner the treatment is, the better.
What are extrapyramidal symptoms?
All these symptoms can occur both in adults and children and may be severe. Early symptoms may start shortly after starting the drug. They can usually occur a few hours after the first dose and may also occur within the first few weeks. The timing may be due to a particular side effect. Delayed symptoms occur after using the drug for a while. The symptoms are as follows:
Akathisia: With akathisia, the person may feel himself / herself tense and very restless; In children this may occur as physical discomfort, agitation, anxiety or general irritability. It can be seen that continuous stepping, ie pacing, shaking legs or feet, rubbing the face, helping to alleviate restlessness.
Research shows that akathisia risk increases with higher doses of medication. Symptoms are also associated with another condition called tardive dyskinesia. 5 to 36 percent of individuals using antipsychotics may develop akathisia in any way. Some drugs, including beta-blocker drugs, can help relieve symptoms. Decreasing the antipsychotic drug dose may also lead to recovery.
Acute dystoniaDystonic reactions are involuntary muscle contractions. These movements are often repetitive and, inter alia, may include eye spasms or continuous blinking, dizziness, tongue sagging and contraction neck. The movements can be very short, but they can affect posture or harden the muscles for a while. Although they appear in other parts of the body, they usually affect the head and neck. Dystonia can cause painful muscular stiffness and other disorders. In addition, if the reaction affects the muscles in the throat, it can be suffocated or breathing problems may occur.
Statistics indicate that 25 to 40 percent of people using antipsychotics live in acute dystonia anywhere, but they are more common in children and young adults. It usually starts within 48 hours of using an antipsychotic and usually requires treatment. Antipsychotic drug may help in the treatment of lowering the dose. Dystonic reactions can also be treated with antihistamines and drugs that treat symptoms of Parkinson’s disease.
parkinsonism: Parkinsonism describes symptoms similar to Parkinson’s disease. The most common symptom is the hard muscles in the limbs. There may also be tremors, increased salivation, slow motion, posture, or changes in walking. Usually they start slowly a few days after the antipsychotic has been used. The dose may affect whether this side effect is improved. The severity of symptoms varies, but may affect movement and function. In some cases, treatment may be needed when they eventually go on their own . Treatment usually involves lowering the dose or using a different antipsychotic. Drugs used to treat symptoms of Parkinson’s disease may also be used to treat symptoms of this disease.
Neuroleptic Malignant Syndrome (NMS)
This reaction is rare but very serious. In general, the first signs are stiff muscles, fever, then numbness or confusion. It may also experience seizures and affect the function of the nervous system. Symptoms usually occur several hours after they start using antipsychotics. Research shows that this disorder is not more than 0.02 percent. This condition can cause coma, kidney failure and death. It is most often associated with starting with an antipsychotic drug, but it is also linked to stopping or replacing drugs at the same time. The treatment includes stopping the antipsychotic agent immediately and providing supportive medical care. Emergency medical care may take two weeks or more, but complete recovery is usually possible.
Tardive dyskinesia is a late onset extrapyramidal symptom. It includes repetitive, involuntary facial movements, such as tongue twisting, chewing movements and lip smacking, cheek swelling. In addition, changes in walking, jerky, limb movements or shrug may also occur. Usually it does not develop until the drug is used for six months or longer and symptoms may persist despite treatment. Women are more likely to have this side effect. Conditions such as age, diabetes, symptoms of negative schizophrenia, or symptoms affecting the typical function may increase the risk. Among those using first-generation antipsychotics, this side effect can be seen up to about 30 percent. Treatment includes stopping the drug, lowering the dose, or switching to another drug. For example clozapine,
Subtypes of Tardive Dyskinesia
• If dystonia has occurred in the past: This subtype is more severe than acute dystonia and usually involves slower twist movements in the body, such as withdrawing on one side of the neck or body.
Permanent or chronic akathisia: This refers to symptoms of akathisia, such as leg movements, arm movements, or swinging, which take one month or longer while taking the same dose of the drug.
Both of these can be started later and persist despite treatment, but the types of movement associated with these symptoms may be different. Children who stop taking drugs suddenly may have withdrawal dyskinesia. These jerky and repetitive movements are usually seen in the body, neck and limbs. They usually go on their own in a few weeks, but restarting the drug and gradually decreasing the dose may reduce the symptoms.
What Causes Extrapyramidal Symptoms?
The extrapyramidal system is a neural network that helps regulate motor control and coordination in the brain. It contains basal ganglia with a number of important structures for motor function. Basal ganglia need dopamine for proper functioning.
Antipsychotics help to improve symptoms by binding to dopamine receptors in the central nervous system and blocking dopamine. This may prevent the basal ganglia from receiving enough dopamine. As a result, extrapyramidal symptoms may develop. While the first generation antipsychotics usually cause extrapyramidal symptoms, the second-generation antipsychotics tend to occur at lower rates. These drugs have less affinity for dopamine receptors, bind loosely and block some serotonin receptors.
First generation antipsychotics include:
• Flufenazine •
Second generation antipsychotics include:
How is extrapyramidal symptoms diagnosed?
It is important to pay attention to these symptoms if the person and the person they know are using antipsychotics. The drug side effects are sometimes similar to the symptoms of the condition used in the treatment of a drug, but the doctor can help in the diagnosis of symptoms. The doctor may ask for symptoms and observe the difficulties experienced by the person during his / her movement or coordination during an appointment.
They may also use an assessment scale such as the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) or the Extrapyramidal Symptoms Rating Scale (ESRS). These scales can provide more information about symptoms and severity.
How is extrapyramidal symptoms treated?
Treatment of extrapyramidal symptoms may be difficult. Medications can have different side effects can affect different ways and there is no way to predict the response. Usually the only treatment is to try different drugs or lower doses to see the most relief with minimal side effects. Depending on the symptoms, another type of drug may be given with antipsychotics to help treat them. Without the doctor, the drug should never adjust or change the dose.
Changing the dose or drug may cause other symptoms, so the doctor should be informed about the undesirable side effects. If there is a lower dose of antipsychotic prescription, the doctor should be told to the doctor or therapist when the symptoms or other symptoms of psychosis should be treated. If hallucinations, delusions or other disturbing symptoms occur, help should be obtained immediately. These symptoms may increase the risk of harm to oneself or someone else, so the doctor may want to try a different treatment approach.
Talking to the therapist can help if you experience difficulties as a result of extrapyramidal symptoms. Therapy cannot directly address side effects, but can support ways to cope when symptoms affect daily life or cause distress.
In some cases, extrapyramidal symptoms may not affect the individual too much, and in some cases they may be painful or irritating. They may adversely affect quality of life and contribute to disappointment and distress. If there are side effects, the drug may be discontinued, but this can be dangerous, and more severe symptoms may occur when the drug is discontinued. Therefore, it is important that the person keeps his / her medicine appropriately until you talk to your doctor.
If you experience any side effects when using antipsychotics, you should talk to the doctor as soon as possible. In some cases, this discomfort can be permanent, but treatment usually leads to recovery.
It is a proposal and Information article that has been compiled from different sources. There is no definitive diagnosis and treatment. Ask your doctor about any health problems. Remember, the treatment methods applied in health problems may vary according to the biology of individuals, hereditary characteristics, age, height, weight differences, allergic aspects and dozens of such conditions. Only your doctor can help you in the treatment of your health problems.