Extrapyramidal symptoms
[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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