Extrapyramidal symptoms

From WikiMD's Wellness Encyclopedia

[Extrapyramidal symptoms]] (EPS), are side effects typically associated with certain medications, particularly antipsychotics and neuroleptics. These symptoms reflect dysfunction in the extrapyramidal system, a neural network in the brain that controls motor function and is regulated by the basal ganglia, a group of structures in the brain's cerebral cortex.

Clinical Presentation[edit | edit source]

Extrapyramidal symptoms encompass a range of movement disorders, including dystonia, akathisia, parkinsonism, and tardive dyskinesia.

  • Dystonia is characterized by persistent spasms and muscle contractions that can cause abnormal postures or repetitive movements.
  • Akathisia is a state of restlessness that manifests as an inability to stay still, often accompanied by a subjective sense of discomfort.
  • Parkinsonism is a syndrome mimicking Parkinson’s disease, with symptoms such as bradykinesia (slowness of movement), rigidity, and tremor.
  • Tardive dyskinesia is a condition marked by irregular, jerky movements, often affecting the face.
  • EPS can be acute, presenting shortly after the initiation of treatment, or chronic, developing after prolonged use of the offending medication.

Etiology and Risk Factors[edit | edit source]

EPS are primarily associated with the use of drugs that block dopamine receptors in the brain, such as antipsychotics and some antiemetics. First-generation or "typical" antipsychotics, like haloperidol and chlorpromazine, carry a higher risk of EPS compared to second-generation or "atypical" antipsychotics.

Individual susceptibility to EPS may also be influenced by factors such as age, sex, and genetic predisposition.

Diagnosis and Management[edit | edit source]

The diagnosis of EPS is primarily clinical, based on the presentation of characteristic symptoms and a history of exposure to a causative drug.

The management of EPS involves reducing the dose of the causative drug, switching to a drug with a lower risk of EPS, or using adjunctive treatments like anticholinergic medications or dopamine agonists. In severe cases, hospitalization may be necessary.

Impact on Treatment Adherence[edit | edit source]

EPS can significantly impact adherence to medication regimens. In clinical trials, they are a common reason for participant dropouts. Thus, it is crucial for healthcare providers to monitor for EPS and manage them promptly to optimize patient outcomes.

References[edit | edit source]

  • [1] Stahl, S. M. (2018). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications. Cambridge University Press.
  • [2] Kane, J. M., & Correll, C. U. (2020). Optimizing treatment choices to improve adherence and outcomes in schizophrenia. Journal of Clinical Psychiatry, 81(5).
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Contributors: Prab R. Tumpati, MD