Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0013421 (dystonia)
 8,418 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

For patients receiving neuroleptics, age, sex, neuroleptic potency, and dose all influence the likelihood of a dystonic reaction. Little is known, however, of the relative importance of these factors or of the feasibility of predicting dystonia in individual patients. We reviewed 135 charts of psychotic inpatients to examine these factors and their usefulness in predicting dystonia. Age, sex, neuroleptic type, dose, and occurrence of dystonia were recorded for the first 4 days of drug treatment and were used to construct a linear discriminant function that classified the cases as to whether dystonia was expected. Internal cross-validation was performed, and the error rate of this classification procedure was calculated. Forty-nine (36%) of the patients had dystonia. A younger age was the most powerful predictor of dystonia. Male gender was second in predictive power with minor effects from neuroleptic dose and potency. The overall error rate (false-positive and false-negative errors combined) of the discriminant function was 30%. These results suggest the possibility of predicting dystonia in individual patients but should be regarded with caution since the predictive procedure has not been tested prospectively. If confirmed, these data may allow treatment strategies that protect patients from dystonia while sparing patients not at risk unnecessary treatment with antiparkinson agents.
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PMID:Prediction of neuroleptic-induced dystonia. 257 89

Antipsychotic drugs have an important place in pharmacologic treatment of depression. Major depression with psychotic features responds poorly to treatment if an antipsychotic is not used in addition to an antidepressant; however, an antipsychotic confers no additional benefit in nonpsychotic depression. Antipsychotic drugs do have significant short- and long-term side effects, including pseudoparkinsonism, dystonia, akathisia, and tardive dyskinesia. The possibility of a good therapeutic response with minimal side effects can be increased if psychotic depression is diagnosed accurately and the antipsychotic is prescribed according to established clinical guidelines.
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PMID:Use of antipsychotic drugs in depression. Problems and opportunities. 289 Nov 24

A 31-year-old man with psychosis and neuroleptic-induced tardive dystonia developed neuroleptic malignant syndrome (NMS) while taking haloperidol. Muscle rigidity responded to dantrolene, but hyperthermia did not abate until therapy with carbidopa/levodopa was initiated, after which temperature varied in direct relationship to subsequent levodopa administration. This supports the role for central dopaminergic mechanisms in the pathogenesis of NMS.
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PMID:Neuroleptic malignant syndrome responsive to carbidopa/levodopa: support for a dopaminergic pathogenesis. 350 73

Neuroleptic-induced tardive dystonia is frequently refractory to therapy. We describe a 13-year-old girl with neuronal ceroid-lipofuscinosis who developed dystonia after beginning treatment with thioridazine for acute psychosis. Although anticholinergic drugs and benzodiazepines were ineffective, the patient improved with baclofen. Patients with certain degenerative diseases of the central nervous system may be at increased risk for the development of drug-induced dystonia, and we caution against the use of neuroleptics in these patients.
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PMID:Drug-induced dystonia in neuronal ceroid-lipofuscinosis. 350 94

This 6-day study evaluated the efficacy of equivalent doses of loxapine and thiothixene for rapid tranquilization of acutely disturbed, psychotic patients. After initial tranquilization with intramuscular injections for 24 hours, 58 patients were treated for 5 days with oral medication. With both drugs, intramuscular treatment demonstrated clinically significant improvement from baseline on Clinical Global Impressions and Brief Psychiatric Rating scales; this improvement continued during the oral phase. Median time to tranquilization was significantly less with loxapine (60 minutes) than with thiothixene (95 minutes); during the oral phase, there were no significant differences between the two treatment groups. Side effects were minimal during the intramuscular phase; dystonia was most common during the oral phase.
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PMID:Rapid tranquilization: a comparison of thiothixene with loxapine. 371 Oct 26

Two patients developed either blepharospasm or blepharospasm-oromandibular dystonia following chronic therapy with chlorpromazine, haloperidol, or thioridazine. In one patient, appearance of the movement disorder was associated with neuroleptic withdrawal, and in the other patient, the movement disorder began while neuroleptic therapy continued. Because of the age of one patient and the severe intermittent psychosis in the other, these Meige-like symptoms were attributed to chronic neuroleptic use rather than to spontaneously occurring Meige syndrome. The symptoms occurring as part of a tardive dyskinesia suggest that dopaminergic mechanisms play a role in idiopathic Meige syndrome.
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PMID:Meige syndrome (blepharospasm-oromandibular dystonia) after long-term neuroleptic therapy. 611 44

Initial prophylaxis with anticholinergics for neuroleptic-induced extrapyramidal syndromes (EPSs) is controversial. Recommendations, based on conflicting research findings, vary from routine prophylactic use of anticholinergics to withholding these agents until dystonia, akathisia, or parkinsonism develops. To determine whether anticholinergic prophylaxis influenced EPS rates during the first 21 days of neuroleptic treatment, 215 psychotic inpatients were reviewed. Initial prophylaxis with anticholinergic drugs significantly reduced the occurrence of EPSs. This treatment's efficacy depended on a complex interaction of variables, including the patient's sex and age, antipsychotic drug type and dose, and treatment phase.
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PMID:Initial anticholinergic prophylaxis for neuroleptic-induced extrapyramidal syndromes. 613 11

Hexosaminidase deficiency diseases or GM2-gangliosidoses were originally described as infantile encephalopathies. Recently, hexosaminidase deficiencies have been found with different phenotypes, including juvenile and adult encephalopathies, cerebellar ataxias, and motor neuron diseases. Individual cases have resembled Ramsey-Hunt syndrome, olivopontocerebellar ataxia, Friedreich ataxia, amyotrophic lateral sclerosis, Kugelberg-Welander disease, Fazio-Londe disease, and Charcot-Marie-Tooth disease. Tremor, dystonia, spastic paresis, and psychosis have been seen. Since few diagnosable causes for these system atrophies are known, these patients should be tested for hexosaminidase deficiency. These recessive disorders fit a multiple loci/multiple alleles genetic scheme, and a clinical genetic classification is presented.
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PMID:The clinical spectrum of hexosaminidase deficiency diseases. 719 92

Patients with AIDS dementia complex (ADC) appear to have an increased likelihood of developing acute onset parkinsonism and dystonia when treated with dopamine antagonists. It has been hypothesized, based on clinical evidence, that hypersensitivity to these drugs in ADC is probably related to direct invasion of the basal ganglia by the HIV virus and a secondary alteration in dopaminergic mechanisms. We report the first pathological description of a patient with ADC who developed acute onset, generalized rigidity and dystonia after a brief trial of low dose neuroleptic therapy administered for psychotic symptoms. An unusual clinical feature of this case was the persistence of his movement disorder. Pathological examination revealed a generalized encephalitic process with substantial neuronal loss observed primarily in the medial and lateral globus pallidus. Correlation with a current model of basal ganglia pathophysiology and other disorders with pallidal lesions is discussed. Clinical and pathological features of this case confirm the previous contention and indicate that dopamine antagonists should be utilized with extreme caution in patients with ADC.
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PMID:Persistent neuroleptic-induced rigidity and dystonia in AIDS dementia complex: a clinico-pathological case report. 769 86

Dentatorubropallidoluysian atrophy is a neurodegenerative disorder with characteristic pathology, chiefly described in reports from Japan, and is associated with an unstable CAG trinucleotide repeat in a gene on chromosome 12. We describe four European families, three British and one Maltese, with this mutation. All exhibited autosomal dominant inheritance, and there was evidence for anticipation associated with an increase of the expansion with paternal transmission in two families. Affected chromosomes from patients with dentatorubropallidoluysian atrophy had CAG expansions of 58 to 74 repeats, compared to 7 to 26 in control chromosomes, and the size of repeat was significantly inversely correlated with age of onset. The clinical features were diverse, even within individual families, and comprised a combination of a movement disorder (chorea, myoclonus, dystonia, or parkinsonism), cerebellar ataxia, epilepsy, psychosis, and dementia. A clinical diagnosis of Huntington's disease had been made in affected individuals from all families. Neuropathological examination of 2 patients showed no specific abnormality in one and degenerative changes predominantly affecting the spinal cord in the other. Investigation of 55 patients who might represent sporadic examples of dentatorubropallidoluysian atrophy did not detect any expanded alleles. Dentatorubropallidoluysian atrophy is likely to be more common than previously recognized in non-Japanese populations, and should be considered in any patient with a dominantly inherited neurodegenerative disorder with the above-mentioned clinical features.
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PMID:A clinical and molecular genetic study of dentatorubropallidoluysian atrophy in four European families. 771 81


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