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)

Idiopathic orofacial dyskinesia, also called Brueghel's syndrome, blepharospasm-oromandibular dystonia, and Meige dystonia, is characterized by involuntary facial movements. Since this disorder can be difficult to distinguish from tardive dyskinesia, we have generated a neuropharmacologic profile of Meige dystonia. Symptoms were improved by antagonists of both dopamine and acetylcholine and worsened by the cholinergic agonist physostigmine, consistent with a hypothesis of relative excess in both dopamine and acetylcholine neuronal activities. Since tardive dyskinesia is hypothesized to be characterized by dopamine excess and acetylcholine deficiency, a physostigmine infusion may help differentiate these two disorders by exacerbating Meige dystonia but improving tardive dyskinesia.
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PMID:Pharmacologic characteristics of Meige dystonia: differentiation from tardive dyskinesia. 717 19

We compared acute effects of single intravenous administrations of metoclopramide (40 mg) and placebo in a double-blind crossover study involving 81 patients with tardive dyskinesia. Metoclopramide produced significantly greater reduction in mean total Abnormal Involuntary Movement Scale score as well as in ratings for six of the seven body areas, when compared with placebo. On adjusting each patient's metoclopramide response for his or her placebo response, we found that 35 of the 81 patients had 50% or greater placebo-corrected improvement. There were no apparent clinical differences between metoclopramide responders and nonresponders. Administration of 60 mg of metoclopramide to 15 patients produced greater improvement in tardive dyskinesia as compared with 40 mg; the incidence of acute dystonia, however, jumped from 10% with 40 mg to 33% with 60 mg.
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PMID:Effects of intravenous metoclopramide in 81 patients with tardive dyskinesia. 717 60

Estrogen have been reported in animal studies to both enhance and block central dopaminergic activity and in one clinical report to improve tardive dyskinesia. In the present study estrogen (Premarin, 2.5 mg per day) administration caused varying degrees of improvement in less than one-third of 21 patients with chorea due to Huntington's disease and tardive dyskinesia and had no effect in eight patients with dystonia. Estrogens appear to have an antidopaminergic effect in humans but poses only limited efficacy in the treatment of dyskinetic disorders.
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PMID:Estrogen treatment of dyskinetic disorders. 720 Feb 10

We present two women with Meige's syndrome, a condition in which the clinical presentation differs from tardive dyskinesia by the lack of exposure to neuroleptic drgus, greater severity of blepharospasms, and more prolonged dystonic contractions of oromandibular muscles. In this condition we used triaxial accelerometry to detect dystonia, which may also appear in limb and respiratory muscles. Although psychologic factors may affect the symptoms, the basic pathogenesis of this syndrome does not seem to be psychogenic. We think that biochemical abnormalities in the basal ganglia are responsible for the dyskinesias and submit data suggesting a reduction of dopamine turnover in the central nervous system of one patient. Both patients have evidence of autoimmune diseases, and one patient's dystonic movements responded to immunosuppressive therapy, suggesting that autoimmune processes contribute to the pathogenic mechanism of Meige's syndrome in some instances.
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PMID:Meige's syndrome. 738 44

In a population of 200 consecutive inpatients with a history of at least 3 months' total cumulative neuroleptic exposure, the prevalence of tardive dystonia (TDt) was 4%, higher than previously reported. The prevalence of tardive dyskinesia (TDk) was 22%. Patients with TDt did not differ in demographic or clinical variables from nondyskinetic patients. In comparison with patients with TDk, patients with TDt were significantly younger, had a more severe movement disorder, and had received neuroleptics for the first time fewer years before. Patients with TDk were significantly older than patients without tardive disorders, both when they were examined and when they had started their first neuroleptic treatment. Furthermore, they had started their first neuroleptic treatment more years before. These results support the distinction between TDt and TDk, and suggest that the previously reported prevalence of TDt might have been underestimated.
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PMID:Tardive dystonia. Prevalence, risk factors, and comparison with tardive dyskinesia in a population of 200 acute psychiatric inpatients. 766 21

This paper reports on a case of spasmodic torticollis after longterm treatment with neuroleptics. This form of dystonia is called tardive dystonia to distinguish it from tardive dyskinesia. Its pathophysiology is unknown. Pathological changes are described in the basal ganglia. Increased signal was found on magnetic resonance imaging on both sides of the basal ganglia reflecting structural lesions. These structural changes, together with neuroleptic medication, represent predisposing factors for the manifestation of tardive dystonia.
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PMID:[Tardive dystonia. A rare neuroleptic-induced disease picture]. 781 58

The authors present a basic review on clozapine (Leponex, Clozaril) which is one of the atypical antipsychotic drugs. It is a derivative of dibenzodiazepine, which contrary to classical neuroleptic drugs, does not exert a marked effect on the extrapyramidal system and its long-term use is not associated with the risk of development of irreversible tardive dyskinesia or dystonia. It is effective also in patients who are resistant to treatment with other neuroleptics and it has a more favourable effect on the negative symptoms of schizophrenia than classical neuroleptics. Its disadvantage is the increased risk of granulocytopenia and agranulocytosis (2%) and therefore its use is justified only in patients where there is evidence that they are resistant to other treatment. The mentioned risk can be controlled effectively by regular checks of the haemogram in patients taking clozapine, along with recording in the central data bank which has a consulting and control function and guaranteeing the method of correct administration of this drug and early therapeutic provisions in case of granulocytopenia. Despite the cost of treatment and checks of the haemogram, clozapine reduces the sum total of expenditure associated with the treatment of chronic schizophrenia by reducing the number of re-admissions to hospital, by shortening the period of hospitalization and by cutting indirect costs, which are influenced by a greater sociability of the patient and a greater probability of successful comprehensive therapeutic procedures.
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PMID:[Clozapine--an atypical antipsychotic agents, its advantages and risks]. 785 23

The author reviews the relationship between extrapyramidal syndromes (EPS) such as dystonia, akathisia and parkinsonism, and tardive dyskinesia (TD), characterized clinically by late-onset repetitive movements. While the pathophysiological mechanisms are unclear, neuroleptic-induced EPS have been shown to be associated with a higher risk of TD. The appearance of EPS, however, has not been shown to predict the occurrence of TD. It has been hypothesized that dopamine hypofunction resulting in EPS may lead to the development of dopamine receptor supersensitivity, thereby increasing the TD risk. If this theory can be validated in the clinical setting, atypical neuroleptics (for example, clozapine, risperidone) with a lower EPS liability may result in a lower incidence of TD.
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PMID:Clinical relationship of extrapyramidal symptoms and tardive dyskinesia. 787 68

Since the introduction of chlorpromazine in the 1950s, neuroleptic medications have been the mainstay of treatment of schizophrenia and other psychotic disorders. These medications do not always lead to complete remission of symptoms but they have allowed many patients to lead more productive and satisfying lives away from the restrictions of chronic hospitalisation. However, neuroleptics are associated with a number of adverse effects that can compromise their effectiveness. Extrapyramidal adverse effects include acute dystonic reactions, neuroleptic-induced Parkinsonism and akathisia. They can often be treated with neuroleptic dose reduction, addition of anticholinergic or beta-blocking agents, or medication change. Later-onset movement disorders such as tardive dyskinesia or dystonia require careful evaluation and may be treated with dose reduction or change of neuroleptic to an atypical agent. Potentially fatal reactions such as agranulocytosis and neuroleptic malignant syndrome can rarely occur and often require significant medical intervention. Clozapine offers some advantages over 'typical' neuroleptics but has a unique adverse effect profile which includes agranulocytosis.
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PMID:Adverse effects of antipsychotic drugs. 790 81

Among the tardive dyskinesia syndromes, dystonia can be the most difficult to treat. It may be severe to the point of being disabling, yet the patients may require antipsychotic medications for an even more disabling psychosis. Clozapine, an atypical neuroleptic drug that lacks extrapyramidal effects, may be the drug of choice for such patients. This report describes three patients with significant dystonia, previously disabled by their psychoses, who have been successfully managed with clozapine plus other agents for > 3 years.
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PMID:Clozapine treatment of psychosis in patients with tardive dystonia: report of three cases. 791 39


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