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Chapter 14 - Drug-induced movement disorders

from Section III - Iatrogenic and toxic movement disorders

Published online by Cambridge University Press:  05 April 2014

By
Shyamal H. Mehta  and
Kapil D. Sethi
Edited by
Werner Poewe  and
Joseph Jankovic
Shyamal H. Mehta
Affiliation:
Movement Disorders Program, Georgia’s Health Sciences University, Augusta, GA, USA
Kapil D. Sethi
Affiliation:
Movement Disorders Program, Georgia’s Health Sciences University, Augusta, GA, USA
Werner Poewe
Affiliation:
Medical University Innsbruck
Joseph Jankovic
Affiliation:
Baylor College of Medicine, Texas
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Summary

Movement disorders attributable to prescribed medications and drugs of abuse are commonly encountered in the clinic. This chapter will review the wide variety of movement disorders due to dopamine-receptor blocking agents (DBAs), other medications, and the drugs of abuse.

Movement disorders due to DBAs

Antipsychotic agents, also termed neuroleptics or dopamine-receptor blocking agents (DBAs), are extensively utilized in the management of psychiatric disorders such as schizophrenia and bipolar disorders, and DBAs are employed in the treatment of neurological diseases such as Tourette’s syndrome, Huntington’s disease, psychosis in Parkinson’s disease, and dementias such as dementia with Lewy bodies. In addition, metoclopramide (MCP) is widely used to treat gastrointestinal motility disorders. The introduction of chlorpromazine in the early 1950s was nothing short of a miracle in the treatment of psychosis, but it was soon realized that there were significant neurological side effects associated with this class of drugs. Extrapyramidal side effects (EPS) was an umbrella term used to describe these side effects. Initially, it was thought that the induction of EPS was integral to the clinical antipsychotic efficacy of chlorpromazine and a dopamine depleter reserpine. More recently with the advent of clozapine, this tight linkage between EPS and antipsychotic efficacy has been shown to be fallacious. The evidence implicates the degree of D2 receptor antagonism and the speed of dissociation in the development of these EPS (DBAs with less D2 affinity and more rapid dissociation are less likely to produce EPS). In addition, the blockage of other neurotransmitter receptors such as 5-hydroxytryptamine (5-HT2) receptors may be important, allowing the development of drugs that are less likely to cause movement disorders.

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Information
Movement Disorders in Neurologic and Systemic Disease , pp. 203 - 219
Publisher: Cambridge University Press
Print publication year: 2014

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  • Drug-induced movement disorders
    • By Shyamal H. Mehta, Movement Disorders Program, Georgia’s Health Sciences University, Augusta, GA, USA, Kapil D. Sethi, Movement Disorders Program, Georgia’s Health Sciences University, Augusta, GA, USA
  • Edited by Werner Poewe, Joseph Jankovic, Baylor College of Medicine, Texas
  • Book: Movement Disorders in Neurologic and Systemic Disease
  • Online publication: 05 April 2014
  • Chapter DOI: https://doi.org/10.1017/CBO9781139175845.015
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  • Drug-induced movement disorders
    • By Shyamal H. Mehta, Movement Disorders Program, Georgia’s Health Sciences University, Augusta, GA, USA, Kapil D. Sethi, Movement Disorders Program, Georgia’s Health Sciences University, Augusta, GA, USA
  • Edited by Werner Poewe, Joseph Jankovic, Baylor College of Medicine, Texas
  • Book: Movement Disorders in Neurologic and Systemic Disease
  • Online publication: 05 April 2014
  • Chapter DOI: https://doi.org/10.1017/CBO9781139175845.015
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Drug-induced movement disorders
    • By Shyamal H. Mehta, Movement Disorders Program, Georgia’s Health Sciences University, Augusta, GA, USA, Kapil D. Sethi, Movement Disorders Program, Georgia’s Health Sciences University, Augusta, GA, USA
  • Edited by Werner Poewe, Joseph Jankovic, Baylor College of Medicine, Texas
  • Book: Movement Disorders in Neurologic and Systemic Disease
  • Online publication: 05 April 2014
  • Chapter DOI: https://doi.org/10.1017/CBO9781139175845.015
Available formats
×