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Rissardo JP, Vora N, Mathew B, Kashyap V, Muhammad S, Fornari Caprara AL. Overview of Movement Disorders Secondary to Drugs. Clin Pract 2023; 13:959-976. [PMID: 37623268 PMCID: PMC10453030 DOI: 10.3390/clinpract13040087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
Drug-induced movement disorders affect a significant percentage of individuals, and they are commonly overlooked and underdiagnosed in clinical practice. Many comorbidities can affect these individuals, making the diagnosis even more challenging. Several variables, including genetics, environmental factors, and aging, can play a role in the pathophysiology of these conditions. The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD) are the most commonly used classification systems in categorizing drug-induced movement disorders. This literature review aims to describe the abnormal movements associated with some medications and illicit drugs. Myoclonus is probably the most poorly described movement disorder, in which most of the reports do not describe electrodiagnostic studies. Therefore, the information available is insufficient for the diagnosis of the neuroanatomical source of myoclonus. Drug-induced parkinsonism is rarely adequately evaluated but should be assessed with radiotracers when these techniques are available. Tardive dyskinesias and dyskinesias encompass various abnormal movements, including chorea, athetosis, and ballism. Some authors include a temporal relationship to define tardive syndromes for other movement disorders, such as dystonia, tremor, and ataxia. Antiseizure medications and antipsychotics are among the most thoroughly described drug classes associated with movement disorders.
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Affiliation(s)
| | - Nilofar Vora
- Medicine Department, Terna Speciality Hospital and Research Centre, Navi Mumbai 400706, India;
| | - Bejoi Mathew
- Medicine Department, Sri Devaraj Urs Medical College, Kolar Karnataka 563101, India;
| | - Vikas Kashyap
- Medicine Department, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India;
| | - Sara Muhammad
- Neurology Department, Mayo Clinic, Rochester, MN 55906, USA;
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Zhou DJ, Pavuluri S, Snehal I, Schmidt CM, Situ-Kcomt M, Taraschenko O. Movement disorders associated with antiseizure medications: A systematic review. Epilepsy Behav 2022; 131:108693. [PMID: 35483204 PMCID: PMC9596228 DOI: 10.1016/j.yebeh.2022.108693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022]
Abstract
New-onset movement disorders have been frequently reported in association with the use of antiseizure medications (ASMs). The frequency of specific motor manifestations and the spectrum of their semiology for various ASMs have not been well characterized. We carried out a systematic review of literature and conducted a search on CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Scopus from inception to April 2021. We compiled the data for all currently available ASMs using the conventional terminology of movement disorders. Among 5123 manuscripts identified by the search, 437 met the inclusion criteria. The largest number of reports of abnormal movements were in association with phenobarbital, valproic acid, lacosamide, and perampanel, and predominantly included tremor and ataxia. The majority of attempted interventions for all agents were discontinuation of the offending drug or dose reduction which led to the resolution of symptoms in most patients. Familiarity with the movement disorder phenomenology previously encountered in relation with specific ASMs facilitates early recognition of adverse effects and timely institution of targeted interventions.
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Affiliation(s)
- Daniel J Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Spriha Pavuluri
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Isha Snehal
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Cynthia M Schmidt
- Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, NE, United States
| | - Miguel Situ-Kcomt
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States.
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Moon HJ, Jeon B. Can Therapeutic-Range Chronic Phenytoin Administration Cause Cerebellar Ataxia? J Epilepsy Res 2017; 7:21-24. [PMID: 28775951 PMCID: PMC5540686 DOI: 10.14581/jer.17004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/13/2017] [Indexed: 11/21/2022] Open
Abstract
Phenytoin (PHT) is a first line antiepileptic drug (AED) used to treat many epilepsy syndromes. As with other AEDs, there are various adverse effects associated with PHT. For this brief review, we searched for evidence of cerebellar ataxia as a chronic adverse effect of therapeutic-range PHT treatment. Many previous studies appeared related to this issue, but many of those studies were designed to resolve questions related to the persistent residual effects of toxic-range PHT therapy, or they were inconclusive due to an absence of critical information such as PHT serum concentration, cerebellar symptoms/signs, and other factors contributing to cerebellar degeneration. Nevertheless, there were a few reports suggesting that cerebellar ataxia may be a chronic adverse effect of therapeutic-range PHT therapy and that a possible pathomechanism for that effect is folate deficiency. Moreover, there is the possibility that there may be patient-specific susceptibility factors affecting ataxia. Further studies are needed to elucidate the incidence, risk factors, and pathomechanism of cerebellar ataxia as a chronic adverse effect of therapeutic-range PHT treatment.
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Affiliation(s)
- Hye-Jin Moon
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul, Korea
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Shiek Ahmad B, Wark JD, Petty SJ, O'Brien TJ, Gorelik A, Sambrook PN, Hill KD. Changes in balance function with chronic antiepileptic drug therapy: A twin and sibling study. Epilepsia 2015; 56:1714-22. [DOI: 10.1111/epi.13136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Baemisla Shiek Ahmad
- Department of Medicine; University of Melbourne; The Royal Melbourne Hospital; Parkville Victoria Australia
- Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - John D. Wark
- Department of Medicine; University of Melbourne; The Royal Melbourne Hospital; Parkville Victoria Australia
- The Royal Melbourne Hospital Bone and Mineral Medicine; Parkville Victoria Australia
| | - Sandra J. Petty
- Department of Medicine; University of Melbourne; The Royal Melbourne Hospital; Parkville Victoria Australia
- The Florey Institute of Neuroscience and Mental Health; Parkville Victoria Australia
- Ormond College; Parkville Victoria Australia
| | - Terence J. O'Brien
- Department of Medicine; University of Melbourne; The Royal Melbourne Hospital; Parkville Victoria Australia
| | - Alexandra Gorelik
- Department of Medicine; University of Melbourne; The Royal Melbourne Hospital; Parkville Victoria Australia
- Melbourne EpiCentre; The Royal Melbourne Hospital; Parkville Victoria Australia
| | - Phillip N. Sambrook
- Department of Medicine; The University of Sydney; Royal North Shore Hospital; New South Wales Sydney Australia
| | - Keith D. Hill
- National Ageing Research Institute; Parkville Victoria Australia
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
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Barrera-Bailón B, Oliveira JAC, López DE, Muñoz LJ, Garcia-Cairasco N, Sancho C. Pharmacological and neuroethological studies of three antiepileptic drugs in the Genetic Audiogenic Seizure Hamster (GASH:Sal). Epilepsy Behav 2013; 28:413-25. [PMID: 23872084 DOI: 10.1016/j.yebeh.2013.05.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/21/2013] [Accepted: 05/22/2013] [Indexed: 12/25/2022]
Abstract
Epilepsy modeling is essential for understanding the basic mechanisms of the epileptic process. The Genetic Audiogenic Seizure Hamster (GASH:Sal) exhibits generalized tonic-clonic seizures of genetic origin in response to sound stimulation and is currently being validated as a reliable model of epilepsy. Here, we performed a pharmacological and neuroethological study using well-known and widely used antiepileptic drugs (AEDs), including phenobarbital (PB), valproic acid (VPA), and levetiracetam (LEV). The intraperitoneal administration of PB (5-20mg/kg) and VPA (100-300mg/kg) produced a dose-dependent decrease in GASH:Sal audiogenic seizure severity scores. The administration of LEV (30-100mg/kg) did not produce a clear effect. Phenobarbital showed a short plasmatic life and had a high antiepileptic effect starting at 10mg/kg that was accompanied by ataxia. Valproic acid acted only at high concentrations and was the AED with the most ataxic effects. Levetiracetam at all doses also produced sedation and ataxia side effects. We conclude that the GASH:Sal is a reliable genetic model of epilepsy suitable to evaluate AEDs.
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Affiliation(s)
- B Barrera-Bailón
- Institute of Neurosciences of Castilla and León/IBSAL, University of Salamanca, Salamanca, Spain
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Gandelman-Marton R, Arlazoroff A, Dvir Z. Balance performance in adult epilepsy patients. Seizure 2006; 15:582-9. [PMID: 16979352 DOI: 10.1016/j.seizure.2006.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Revised: 08/01/2006] [Accepted: 08/16/2006] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the magnitude of subclinical balance dysfunction in adult epilepsy patients and to assess the relative contribution of different variables to balance impairment. METHODS Balance performance was evaluated by computerized dynamic platform posturography (CDPP) in 25 adult patients following a generalized tonic-clonic seizure (GTCS) and in 11 healthy subjects. RESULTS The GTCS was a breakthrough seizure in 20 patients with epilepsy and a first seizure in 5. Seven of the patients had localization-related epilepsy and 13 had generalized epilepsy. Mean epilepsy duration was 6.6 years. Nineteen of the patients were treated with antiepileptic drugs (AEDs), 16 on monotherapy and three on polytherapy. Brain CT scan and EEG abnormalities were found in 7 and 14 patients, respectively. None of the patients had clinical signs of balance dysfunction. Postural function, measured by Sway Index (SI), was worse in the patients compared to controls. A lower SI was found in patients who did not receive AEDs, had one or two seizures, had a disease duration of less than a year and had a generalized epilepsy. CONCLUSIONS Although the study group was small and heterogeneous and only a small number of parameters have reached statistical significance, it seems that posturography can be helpful in the evaluation of postural stability in adult patients with epilepsy.
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Abstract
Antiepileptic drugs (AEDs) are being used with increasing frequency, not only to manage epilepsy, but also in the treatment of other conditions including neuropathic pain, migraine headaches and psychiatric conditions requiring mood stabilization. Although AEDs as a class are commonly prescribed in older patients and those with a predisposition to imbalance, the effect these drugs exert on gait and equilibrium has received very little study. Data from controlled efficacy and safety trials suggests that some AEDs are more apt to affect balance than others, even at therapeutic doses. In particular, phenytoin, primidone and phenobarbital produce more dizziness than some of the newer AEDs such as lamotrigine, levetiracetam and oxcarbazepine. For some of the other new AEDs, the data are simply not sufficient to estimate their effect on balance. This article reviews the current evidence that may guide the clinician in choosing a medication likely to have a low impact on gait and balance. Considering the risks and morbidity associated with imbalance and falls, particularly in the elderly, the direct effects of AEDs on balance should be examined further.
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Affiliation(s)
- Terry D Fife
- University of Arizona College of Medicine, Barrow Neurological Institute, Visiting Scientist, Mayo Clinic Scottsdale, Phoenix, Arizona, USA
| | - Joseph Sirven
- Mayo Clinic, Mayo Comprehensive Epilepsy Program, Mayo Clinic College of Medicine, Scottsdale, Phoenix, Arizona, USA
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Ravakhah K, West BC. Case report: subacute combined degeneration of the spinal cord from folate deficiency. Am J Med Sci 1995; 310:214-6. [PMID: 7485226 DOI: 10.1097/00000441-199511000-00007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Subacute combined degeneration of the spinal cord is a rare neurologic complication of folate deficiency. Progressive gait disturbance, weakness, confusion, and depression developed in a 39-year-old man. He had taken phenobarbital for more than 2 years. He was bedbound, with new loss of position and vibration senses in the lower extremities. His hemoglobin was 2.9/dl, mean corpuscular volume 122 fl, vitamin B12 428 pg/ml, and folate 1 ng/ml. Peripheral blood and bone marrow showed megaloblastic anemia. Serum methylmalonic acid and homocysteine levels were consistent with folate deficiency, not B12 deficiency. Treatment with folate and packed erythrocytes resulted at 4 months in overall improvement, including walking. Position sense was restored, and vibration sense had become nearly normal. The authors found no cause for folate deficiency except phenobarbital.
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Affiliation(s)
- K Ravakhah
- Department of Medicine, Meridia Huron Hospital, East Cleveland, OH 44112, USA
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Abstract
The purpose of this study was to determine the influence of age, seizure type and anticonvulsant medication protocol on balance and motor proficiency in 21 subjects with epilepsy (aged seven to 17 years) who did not have mental retardation or cerebral palsy. The Bruininks-Oseretsky balance subtest and a force platform with computer-controlled feedback of the center of force were used to evaluate balance and goal-oriented motion during static and dynamic motor tasks. These motor proficiency and balance assessments may be useful to 'unmask' deficits in motor performance associated with epilepsy, assist the evaluation of anticonvulsant side-effects, and serve as one guide for developing a comprehensive rehabilitation program.
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Affiliation(s)
- K Kowalski
- Gillette Children's Hospital, St Paul, MN, USA
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Young GB, Oppenheimer SR, Gordon BA, Wells GA, Assis LP, Kreeft JH, Lohuis NA, Blume WT. Ataxia in institutionalized patients with epilepsy. Can J Neurol Sci 1994; 21:252-8. [PMID: 8000981 DOI: 10.1017/s0317167100041238] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Fifty-four per cent of 41 chronically institutionalized adult patients with epilepsy had ataxia of gait (wide mean stride width). None of the following correlated with stride width: serum phenytoin, previous phenytoin toxicity, seizure frequency, or status epilepticus. Seventeen of the 41 patients had computed tomographic head scans. Patients with radiological evidence of cerebellar atrophy had a wider mean stride width, later age of onset of seizures, greater peak serum concentrations of phenytoin than did those without cerebellar atrophy. Ataxia of gait was inconsistently associated with cerebellar atrophy. Elevated serum/plasma concentrations of phenytoin may be a risk factor for cerebellar atrophy, but seizure frequency or status epilepticus are not independently related to this complication.
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Affiliation(s)
- G B Young
- Department of Clinical Neurological Sciences, Faculty of Medicine, University of Western Ontario, Canada
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Clarke BM, Upton A, Griffin H, Hudoba P. Balance and cognitive impairment in two epileptic patients before and after vagal nerve stimulation. Pacing Clin Electrophysiol 1991; 14:77-85. [PMID: 1705340 DOI: 10.1111/j.1540-8159.1991.tb04051.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Balance and cognition were assessed in two patients with uncontrolled complex partial seizures. The patients were on anticonvulsant medications and were treated with left vagal stimulation. Balance and cognition were assessed before and after vagal stimulation, and the results were compared with age matched controls and older patients with Parkinson's disease. Severe impairments of function were found in the epileptic patients, and such negative effects of medication make vagal stimulation a potentially practical alternative treatment for uncontrolled epilepsy.
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Affiliation(s)
- B M Clarke
- McMaster University Medical Centre, Hamilton, Ontario, Canada
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