benztropine and Dystonia

Neuroexcitatory movements associated with propofol anesthesia are well recognized. Here we report on the successful use of benztropine (2 mg) to abolish abnormal dystonic movements after propofol anesthesia. Forty-five case reports are reviewed, and a treatment strategy for abnormal movements during propofol anesthesia is provided.

Topics: Anesthetics, Intravenous; Benztropine; Dystonia; Humans; Male; Middle Aged; Muscarinic Antagonists; Propofol

Topics: Adult; Atropine; Benztropine; Chlorpheniramine; Cholinergic Antagonists; Diphenhydramine; Double-Blind Method; Dystonia; Histamine H1 Antagonists; Humans

The authors performed a prospective double-blind study of 39 inpatients beginning high-potency neuroleptics. Patients were randomly assigned to a 7-day course of benztropine or placebo in addition to a neuroleptic. Of 17 patients receiving placebo, eight (47%) suffered an acute dystonic reaction; of 22 patients receiving benztropine, none suffered this reaction--a highly significant difference. The authors also found minimal anticholinergic toxicity attributable to the addition of benztropine to the neuroleptic regimen. These results suggest that an initial 7-day prophylaxis with benztropine is a high-benefit, low-risk adjunctive treatment to neuroleptic therapy.

Topics: Acute Disease; Adolescent; Adult; Antipsychotic Agents; Benztropine; Double-Blind Method; Drug Therapy, Combination; Dystonia; Female; Humans; Male; Prospective Studies; Random Allocation; Tropanes

The effectiveness of antiparkinson medication for the prevention of drug induced dystonias has remained a question. Forty patients with acute psychosis who received high potency oral antipsychotic drugs were interviewed to determine the incidence of acute dystonia. An eleven-fold increase in dystonia was found in patients who received no prophylactic medication. Such prophylaxis appears effective in preventing acute dystonia.

Topics: Adult; Aged; Antipsychotic Agents; Benztropine; Clinical Trials as Topic; Dystonia; Female; Haloperidol; Humans; Male; Middle Aged; Phenothiazines; Schizophrenia; Tropanes

In this report, we discuss the case of a 9-year-old male with Attention Deficit Hyperactivity Disorder (ADHD) on long-term methylphenidate and guanfacine who experienced acute orofacial dystonia that resolved immediately with the administration of benztropine. Current literature describes various cases of methylphenidate-induced dystonia, but ours appears to be the first reported instance of spontaneous dystonia without a recent change in dose or medication change. This may suggest the possibility of methylphenidate-induced dystonia spontaneously occurring several years after initiation.

Topics: Attention Deficit Disorder with Hyperactivity; Benztropine; Central Nervous System Stimulants; Child; Dystonia; Guanfacine; Humans; Male; Methylphenidate

BACKGROUND Antipsychotic medications are associated with multiple adverse effects, including metabolic syndrome, prolonged QT interval, and extrapyramidal symptoms. Acute laryngeal dystonia (ALD) is a rare and lethal form of extrapyramidal reaction. CASE REPORT A 27-year-old woman with schizophrenia on risperidone presented to our Emergency Department with a sensation of choking and respiratory distress, mimicking a panic attack. She developed a generalized dystonic reaction in the hospital, leading to diagnosis risperidone-associated ALD as a cause of her initial problems. She was discharged with an emphasis on being compliant with anticholinergic medication. However, her persistent respiratory symptoms prompted us to revisit the management plan. Her risperidone dose was tapered down to discontinue and an alternate drug was chosen. CONCLUSIONS ALD must be considered as a differential diagnosis when patients on antipsychotic medications present with respiratory distress. Our case highlights the association of ALD with an atypical antipsychotic agent, risperidone. Prompt recognition of this entity is necessary to prevent complications and guide definitive management.

Topics: Adult; Antipsychotic Agents; Benztropine; Dystonia; Female; Humans; Laryngeal Diseases; Risperidone; Schizophrenia

Topics: Adolescent; Antiparkinson Agents; Antipsychotic Agents; Aripiprazole; Benztropine; Bipolar Disorder; Dystonia; Humans; Lithium; Male; Marijuana Abuse; Quetiapine Fumarate; Risk-Taking

A case of acute dystonia related to rivastigmine use is reported.. A 61-year-old Caucasian woman who had suffered from bipolar II disorder with rapid cycling for over 30 years was admitted to an inpatient psychiatry unit. In addition to bipolar II disorder, the patient had been previously diagnosed with early-stage Alzheimer's disease, posttraumatic stress disorder, and various anxiety disorders. During the current hospitalization, she was taking clonazepam, dextroamphetamine, lamotrigine, lansoprazole, levothyroxine, memantine, quetiapine, risperidone, rivastigmine, tranylcypromine, trazodone, and zolpidem. Soon after hospital admission, she began to complain of a tightening in her chest. A review of her records revealed similar complaints during previous hospitalizations. Rivastigmine was discontinued due to concerns of interactions with her antipsychotic regimen. Although these symptoms were previously attributed to anxiety, they appeared worse during this hospitalization. During these events she would be witnessed lying in bed in a supine position with her head canted posteriorly. Benztropine was given to help determine if she was having a dystonic reaction. Within 30 minutes, her chest discomfort began to resolve, and her symptoms resolved completely over the next 48 hours. Three days later, rivastigmine was restarted by the attending psychiatrist because of concerns about the patient's memory, and the dystonia-like symptoms returned within 2 hours of her morning dose. Rivastigmine was discontinued, and benztropine was given and then discontinued, with no return of symptoms for the remainder of her two-week hospitalization.. A patient with bipolar II disorder and mild-to-moderate Alzheimer's disease developed dystonia, possibly caused by rivastigmine. However, the patient was taking various other medications that could have lowered the threshold for extrapyramidal syndromes.

Topics: Acute Disease; Alzheimer Disease; Antipsychotic Agents; Benztropine; Cholinesterase Inhibitors; Comorbidity; Cyclothymic Disorder; Drug Interactions; Dystonia; Extrapyramidal Tracts; Female; Humans; Middle Aged; Phenylcarbamates; Rivastigmine; Syndrome

Topics: Adolescent; Benztropine; Dopamine Agonists; Dopamine Antagonists; Dystonia; Female; Humans; Laryngeal Diseases; Metoclopramide; Nausea

Topics: Adult; Aged; Aged, 80 and over; Benztropine; Dopamine Antagonists; Dystonia; Female; Follow-Up Studies; Haloperidol; Humans; Laryngeal Diseases; Risk Assessment; Trifluoperazine

We describe a case series of five patients with unusual presentations of acute dystonia seen over a 2-week period. Haloperidol, prescribed and allegedly purchased 'on the street', was thought to be a possible cause in each case. Bizarre clinical presentations and delayed onset of symptoms may make diagnosis difficult. A high index of suspicion combined with a careful drug history is essential.

Topics: Adolescent; Adult; Benztropine; Dystonia; Female; Haloperidol; Humans; Illicit Drugs; Ireland; Male; Muscarinic Antagonists

A 53-y-o patient presented approximately 2 h after taking her first dose of nefazadone. Chief complaint was lip smacking with hand and arm gesturing. The patient also took 25 mg meclizine which she had used before with no adverse effects. Diphenhydramine followed by benztropine led to resolution of symptoms within 1 h. Patient subsequently used meclizine with no untoward reactions. Nefazadone should be added to the list of agents that cause acute dystonic reactions.

Topics: Antidepressive Agents, Second-Generation; Antiemetics; Benztropine; Diphenhydramine; Drug Interactions; Dystonia; Female; Humans; Meclizine; Middle Aged; Parasympatholytics; Piperazines; Time Factors; Triazoles

A healthy 3-year-old boy presented to our emergency department with sudden onset of abnormal movement. This patient had been treated for 2 days with conventional doses of an antihistamine/decongestant cold preparation for upper respiratory infection symptoms. The child was confused and restless, with posturing of limbs. Cranial nerve function was intact. Gastric lavage yielded an aspirate the same color as the cold syrup the child had ingested. A diagnosis of dystonic reaction was made, and the child was treated with benztropine, which effected resolution of his symptoms. This is the first reported case in the literature of dystonia induced by an antihistamine and treated with benztropine.

Topics: Benztropine; Child, Preschool; Diphenhydramine; Drug Combinations; Dystonia; Histamine H1 Antagonists; Humans; Male; Nasal Decongestants; Phenylpropanolamine

Topics: Acute Disease; Adult; Benztropine; Drug Interactions; Dystonia; Female; Humans; Injections, Intramuscular; Loxapine; Migraine Disorders; Sumatriptan

The case history presented illustrates that, following an overdose of 'Whizz' and alcohol, a protracted dystonic syndrome can develop, clinically indistinguishable from tetanus. A prolonged period of ventilation may be necessary, but, in this case, complete recovery eventually occurred.

Topics: Adult; Alcoholic Intoxication; Amphetamines; Benztropine; Diagnosis, Differential; Drug Overdose; Dystonia; Ethanol; Humans; Male; Procyclidine; Syndrome; Tetanus

Topics: Adult; Benztropine; Diphenhydramine; Dystonia; Erythromycin Ethylsuccinate; Humans; Male

Topics: Adolescent; Adult; Airway Obstruction; Benztropine; Dystonia; Epiglottis; Humans; Male; Metoclopramide; Prochlorperazine; Radiography

A 27-year-old man was admitted to the emergency department with a fluphenazine decanoate-induced dystonia. He was treated with 125 mg diphenhydramine IV in four doses and 2 mg benztropine IM. A fluctuating response was observed before continued remission of the dystonia. Possible reasons for variable patient responses to diphenhydramine are discussed.

Topics: Adult; Benztropine; Delayed-Action Preparations; Diphenhydramine; Dystonia; Fluphenazine; Humans; Male; Mental Disorders

Young adults treated with a high potency neuroleptic such as haloperidol are at high risk of developing dystonic reactions. In this retrospective study, 15 of 16 young adult patients treated only with haloperidol had such reactions within 60 hours of beginning the drug, while none of the seven patients treated with haloperidol plus prophylactic benztropine mesylate developed dystonia. Although methodologic considerations limit the generalization of these results, they are consistent with other reports and suggest that initial anticholinergic prophylaxis is warranted in young patients treated with high potency antipsychotics. All dystonic reactions in these patients occurred within 2 1/2 days, justifying the consideration of discontinuing prophylaxis (which also causes side effects) after 1 week.

Topics: Acute Disease; Adult; Benztropine; Drug Therapy, Combination; Dystonia; Female; Haloperidol; Humans; Male; Parasympatholytics; Psychotic Disorders; Retrospective Studies; Tropanes

Forty-four adult patients with various forms of dystonia were treated with anticholinergics slowly increased to maximum tolerated doses. Thirty-seven per cent of the 35 idiopathic dystonia patients had a moderate to marked improvement with an average dosage of 21.5 mg of trihexyphenidyl. Younger patients with a shorter duration of dystonia and those who tolerated higher doses tended to benefit most. However there were exceptions to all of these factors. None of the nine patients with symptomatic dystonias improved more than mildly and most had no benefit despite the use of dosages similar to those resulting in improvement in idiopathic dystonia patients. Side effects were common. These often forced drug withdrawal at lower doses than those which might have resulted in improvement. These results suggest that high dose anticholinergics should be the first line of therapy for disabling dystonia.

Topics: Adolescent; Adult; Benztropine; Drug Evaluation; Dystonia; Humans; Leukodystrophy, Metachromatic; Middle Aged; Parasympatholytics; Phenothiazines; Trihexyphenidyl; Wounds and Injuries

We report an unusual case of benztropine-induced acute dystonia and dyskinesia without findings of acute anticholinergic toxicity in a 20-month-old child. Laboratory analysis of blood, urine, and gastric contents demonstrated the presence of an atropinic compound and diphenhydramine only, suggesting the association of benztropine and acute dystonia. Effects of benztropine on neuronal uptake of dopamine may represent a possible mechanism for this unusual adverse effect.

Topics: Accidents; Acute Disease; Benztropine; Dyskinesia, Drug-Induced; Dystonia; Emergencies; Humans; Infant; Male; Therapeutic Irrigation; Tropanes

Topics: Antipsychotic Agents; Basal Ganglia Diseases; Benztropine; Child; Child, Preschool; Creatine Kinase; Diazepam; Diphenhydramine; Dystonia; Humans; Phenothiazines; Tropanes

Dystonic reactions to neuroleptic and antiemetic medications are commonly seen in the outpatient setting. Despite initially successful treatment in the emergency department, symptoms may later recur. We have recently seen several cases of recurrent dystonic reactions; four representative cases are reported. Three of the patients experienced no further dystonic reactions when treated appropriately as outpatients. The fourth patient was lost to follow up. Based on this experience in the pharmacology of the drugs involved in producing and treating dystonic reactions, it is recommended that patients successfully treated in the emergency department for dystonia receive continued outpatient therapy for 48 to 72 hours.

Topics: Acute Disease; Adult; Benztropine; Biperiden; Diphenhydramine; Dystonia; Female; Humans; Jaw; Male; Recurrence; Trihexyphenidyl; Trismus

A patient with Meige's disease was given several pharmacological trials, including muscle relaxants, dopaminergic antagonists, monoamine depletors, anticholinergics, dopamine agonists, cholinergics, benzodiazepines, tricyclic antidepressants, and lithium. Improvement of dystonic movements was best obtained by a combined treatment, haloperidol-benztropine. A review of the literature on Meige's disease is presented. The hypothesis of a simultaneous dopaminergic and cholinergic overactivity is discussed and the use of physostigmine for diagnostic purposes is suggested.

Topics: Aged; Baclofen; Benztropine; Clonazepam; Doxepin; Drug Therapy, Combination; Dystonia; Facial Muscles; Haloperidol; Humans; Levodopa; Male; Spasm

Anticholinergics are one of the most common treatments used in adult-onset focal dystonias although their general efficacy has not been proven. We have investigated the effects of intravenous administration of atropine, benztropine and chlorpheniramine, in comparison to normal saline, in 20 patients with adult-onset focal dystonias (spasmodic torticollis (9), cranial dystonia (6), writer's cramp (5), and have retrospectively reviewed the notes of 78 patients (spasmodic torticollis (38), cranial dystonia (25), writer's cramp (15), who had received chronic oral anticholinergic therapy in varying doses at some time in the past. Patients with spasmodic torticollis and writer's cramp showed no consistent change with any of the intravenous drugs, while the few with cranial dystonia who improved usually did so at the expense of drug-induced sedation. The natural variability of these disorders was evident in the response to normal saline, which caused changes in the scores for severity of the involuntary movements of 20% or more in some patients. Only 8 of the patients who had received chronic oral therapy obtained more than mild benefit, and in 3 of them this improvement was transient. We conclude that cholinergic mechanism are not of general or prime importance in the pathogenesis of adult-onset focal dystonias. However, each new patient warrants a trial of chronic oral anticholinergic therapy in view of the occasional useful responses obtained with these drugs.

Topics: Administration, Oral; Adult; Aged; Atropine; Benztropine; Chlorpheniramine; Dystonia; Female; Handwriting; Humans; Infusions, Parenteral; Male; Middle Aged; Muscle Cramp; Retrospective Studies; Torticollis; Tropanes

Topics: Benztropine; Child; Child, Preschool; Dystonia; Humans; Infant; Metoclopramide

Thirty-two cases of drug-induced dystonic reaction were treated by the author with diphenhydramine or benztropine mesylate, intramuscularly or intravenously, in a prospective, nonrandomized fashion. Recovery time with the two drugs was compared. Benztropine mesylate lessened recovery time in this case series. An epidemiological study of drug-induced dystonic reactions found that most of the patients were drug abusers. The commonest offensive agent in this case series was haloperidol. The most common dystonic reactions seen were buccolingual and torticollic.

Topics: Adolescent; Adult; Benztropine; Diphenhydramine; Dystonia; Female; Haloperidol; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Prospective Studies; Substance-Related Disorders