Toxicity, Medication-Induced Dystonic Reactions Clinical Presentation
- Author: Geofrey Nochimson, MD; Chief Editor: Asim Tarabar, MD more...
History
Dystonic reactions most often occur shortly after initiation of drug treatment; 50% occur within 48 hours and 90% occur within 5 days of initiation of treatment. Risk factors include family history of dystonia, recent history of cocaine or alcohol use, or treatment with a potent dopamine D2 receptor antagonist (eg, fluphenazine, haloperidol).
Onset of symptoms is sudden, usually within minutes to days of initiating or increasing dose of causative agent.
Obtain history from others if patient is not able to speak.
Obtain medication history, including new medications and/or dosage increase.
Physical
Physical examination findings may include any of the following:
- Oculogyric crisis, deviation of eyes in all directions
- Buccolingual crisis
- Protrusion of tongue
- Trismus
- Forced jaw opening
- Difficulty in speaking
- Facial grimacing
- Torticollis, usually associated with oculogyric and buccolingual crisis
- Opisthotonic crisis
- Lordosis or scoliosis
- Tortipelvic crisis - Typically involves hip, pelvis, and abdominal wall muscles, causes difficulty with ambulation
Mental status is unaffected.
Vital signs are usually normal.
Remaining physical examination findings are normal.
Causes
Drug-related adverse effects
Neuroleptics (antipsychotics), antiemetics, and antidepressants are the most common causes of drug-induced dystonic reactions.
Acute dystonic reactions have been described with every antipsychotic.
Alcohol and cocaine use increase risk.[4, 5]
Predisposing factors
- Family history of dystonia
- Viral infections
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