Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 6104  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (382 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References

 Article Access Statistics
    Viewed1666    
    Printed81    
    Emailed0    
    PDF Downloaded70    
    Comments [Add]    
    Cited by others 1    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 6  |  Page : 649-650

Olanzapine-induced task specific tardive dystonia and its response to carbamazepine: A case report


1 Department General (Internal) Medicine,St Columcille's Hospital, Dublin-18, Ireland
2 Department of Radiology, Institute of Neurosciences, Kolkata, India
3 Department of Psychiatry, Institute of Neurosciences, Kolkata, India
4 Department of Neurology and RG Chamaria Research Center, Institute of Neurosciences, Kolkata, India

Date of Web Publication29-Dec-2012

Correspondence Address:
Hrishikesh Kumar
Department of Neurology and RG Chamaria Research Center, Institute of Neurosciences, Kolkata
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.105207

Rights and Permissions



How to cite this article:
Bhattacharjee S, Tiwari M, Dutt A, Kumar H. Olanzapine-induced task specific tardive dystonia and its response to carbamazepine: A case report. Neurol India 2012;60:649-50

How to cite this URL:
Bhattacharjee S, Tiwari M, Dutt A, Kumar H. Olanzapine-induced task specific tardive dystonia and its response to carbamazepine: A case report. Neurol India [serial online] 2012 [cited 2019 Aug 18];60:649-50. Available from: http://www.neurologyindia.com/text.asp?2012/60/6/649/105207


Sir,

Extrapyramidal symptom or dyskinesia induced by Olanzapine are mostly of tardive variety. [1],[2] We report a patient with Olanzapine-induced task specific focal dystonia presenting as jaw opening dystonia and dysphagia.

A 25-year-old male with history of schizophrenia was started on only Olanzapine and dose was gradually titrated up to 10 mg/day with which the psychiatric symptoms improved satisfactorily. After 3 weeks of taking this dose of Olanzapine, he developed jaw opening dystonia [Video 1] and difficulty in swallowing intermittently when he attempted to eat solid food. He had no problem in taking liquid. The movement was not triggered by speech. As psychiatric symptoms were better on Olanzapine, the patient and family members were not willing to reduce or discontinue the medicine. Hematological and biochemical investigations including copper studies and iron studies were normal. Endocrinal work-up showed normal hormonal profile. Magnetic resonance imaging (MRI) brain was normal. Slit lamp examination for Kayser-Fleischer (KF) ring was negative. Modified barium swallow (MBS) study using liquid barium was normal. To bring out the chewing movement during barium study a spongy Indian sweet (rosogollah) was used and it was soaked with liquid barium. When the patient attempted to chew this barium soaked solid food material, he developed jaw opening dystonia, which was evident in the Video 2. Lack of normal propulsive activity in pharynx and upper esophagus was also observed. Significant barium residues in the pharynx were observed post swallow.

Response to carbamazepine in two cases of swallowing-induced oro-pharyngeal dyskinesia was reported previously. [3] Taking cue from these cases, carbamazepine was started, 200 mg three times a day. After 2 weeks of starting treatment, patient's symptoms improved and he was able to chew and eat solid food without any problem [Video 3]. The patient did not have any problem in drinking and swallowing liquid. This further suggests that the chewing movements, which are required to eat solid food, precipitated the movements. We also thought that texture of solid food could have precipitated oro-pharyngeal dyskinesia but this was unlikely as the patient did not develop the abnormal movements just on putting the solid food in mouth. The movements started only after he attempted to chew the solid food material. Our diagnosis was task specific dystonia (chewing induced) that was precipitated by olanzapine. Close differential diagnosis is paroxysmal kinesigenic dyskinesia (PKD) but relatively longer duration of symptoms and well established association between Olanzapine and tardive dyskinesia makes tardive type of focal task specific dystonia the most likely diagnosis.

Tardive dystonia is characterized by local or general sustained, involuntary twisting movements, generally slow, which may affect the limbs, trunk, neck, or face. Tardive dystonia is usually disabling and persistent, and treatment is seldom satisfactory. Olanzapine, is a second generation (atypical) antipsychotic has greater affinity for serotonin H2A receptors than dopamine (D2) receptors. [4] There are reports of both precipitation and remission of tardives dystonia by Olanzapine. There were no case reports with excellent response of task-specific tardive dystonia to carbamazepine despite Olanzapine being continued. [5] Carbamazepine is an effective drug for (PKD) but its role in task specific dystonia is not well documented. In PKD, carbamazepine may be effective as cortical excitation inhibitor. [6] There is also abnormal increase in motor excitability in task-specific dystonia, hence if the same property of cortical excitation inhibitory effect is responsible in this patient for abolishing the dystonia is not clear. [7]

 
  References Top

1.Aggarwal A, Jiloha RC. Olanzapine induced tardive dystonia. Indian J Pharmacol 2008;40:237-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Dunayevich E, Strakowski SM. Olanzapine induced tardive dystonia. Am J Psychiatry 1999:156;1662.  Back to cited text no. 2
[PUBMED]    
3.Kumar H, South A, Jog M. Carbamazepine responsive dysphagia: A variant of paroxysmal kinesigenic dyskinesia? Mov Disord 2011;26:1356-8.  Back to cited text no. 3
[PUBMED]    
4.Gourzis P, Polychronopoulos P, Papapetropoulos S, Assimakopoulos K, Argyriou AA, Beratis S. Quetiapine in the treatment of focal tardive dystonia induced by other atypical antipsychotics-a report of 2 cases. Clin Neuropharmacol 2005;28:195-6.  Back to cited text no. 4
[PUBMED]    
5.Lucetti C, Bellini G, Nuti A, Bernardini S, Dell'Agnello G, Piccinni A, et al. Treatment of patients with tardive dystonia with olanzapine. Clin Neuropharmacol 2002;25:71-4.  Back to cited text no. 5
[PUBMED]    
6.Mir P, Huang YZ, Gilio F, Edwards MJ, Bera rdelli A, Rothwell JC, et al. Abnormal cortical and spinal inhibition in paroxysmal kinesigenic dyskinesia. Brain 2005;128:291-9.  Back to cited text no. 6
    
7.Ikoma K, Samii A, Mercuri B, Wassermann EM, Hallett M. Abnormal cortical motor excitability in dystonia. Neurology 1996;46:1371-6.  Back to cited text no. 7
[PUBMED]    



This article has been cited by
1 Olanzapine
Reactions Weekly. 2013; 1444(1): 28
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow