Tardive and Neuroleptic-Induced Emergencies

  • Paul E. Greene
  • Steven J. FruchtEmail author
Part of the Current Clinical Neurology book series (CCNEU)


Tardive and neuroleptic-induced movement disorders can be among the most dramatic conditions affecting patients. One has only to witness a patient with severe acute jaw dystonia from haloperidol, or watch a patient develop neuroleptic-induced oculogyric crisis to appreciate how sudden and devastating these disorders can be. Fortunately, prompt recognition and treatment are usually effective and, occasionally, lifesaving. This chapter reviews tardive and neuroleptic-induced movement disorder emergencies, and their diagnosis and management.


Vascular Parkinsonism Tardive Dystonia Acute Dystonic Reaction Oculogyric Crisis Meige Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material (110,877 KB)


  1. 1.
    Fitzgerald PM, Jankovic J. Tardive oculogyric crises. Neurology. 1989;39:1434–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Albers VA, Catalano G, Poole MA. Tardive dyskinesia as a result of long-term prochlorperazine use. South Med J. 1996;89:989–91.CrossRefGoogle Scholar
  3. 3.
    Ganzini L, Casey DE, Hoffman WF, McCall AL. The prevalence of metoclopramide-induced tardive dyskinesia and acute extrapyramidal movement disorders. Arch Intern Med. 1993;153:1469–75.PubMedCrossRefGoogle Scholar
  4. 4.
    Micheli FE, Pardal MM, Giannaula R, et al. Movement disorders and depression due to flunarizine and cinnarizine. Mov Disord. 1989;4:139–46.PubMedCrossRefGoogle Scholar
  5. 5.
    Mejia NI, Jankovic J. Metoclopramide-induced tardive dyskinesia in an infant. Mov Disord. 2005;20:86–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Manji H, Howard RS, Miller DH, et al. Status dystonicus: the syndrome and its management. Brain. 1998;121:243–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Koek RJ, Pi EH. Acute laryngeal dystonic reactions to neuroleptics. Psychosomatics. 1989;30:359–64.PubMedCrossRefGoogle Scholar
  8. 8.
    Rowley H, Lynch T, Keogh I, Russell J. Tardive dystonia of the larynx in a quadriplegic patient: an unusual cause of stridor. J Laryngol Otol. 2001;115:918–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Casey DE, Rabins P. Tardive dyskinesias as a life-threatening illness. Am J Psychiatry. 1978;135:486–8.PubMedGoogle Scholar
  10. 10.
    Yassa R, Lal S. Respiratory irregularity and tardive dyskinesia. Acta Psychiatr Scand. 1986;74:506–10.CrossRefGoogle Scholar
  11. 11.
    Greene PE, Kang UJ, Fahn S. Spread of symptoms in idiopathic torsion dystonia. Mov Disord. 1995;10:143–52.PubMedCrossRefGoogle Scholar
  12. 12.
    Sachdev PS, Singh S. Dyskinesia presenting as a respiratory emergency. Med J Aust. 1994;161:726–7.PubMedGoogle Scholar
  13. 13.
    Nishikawa T, Kandea W, Uegaki A, Koga I, Uchida Y, Tanaka M. Respiratory dyskinesia: a variety of clinical forms differentially diagnosed by using a spirograph. Clin Neuropharmacol. 1992;15:315–21.PubMedCrossRefGoogle Scholar
  14. 14.
    Komatsu S, Kirino E, Inoue Y, Arai H. Risperidone withdrawal-related respiratory dyskinesia: a case diagnosed by spirography and fiberoscopy. Clin Neuropharmacol. 2005;28:90–3.PubMedCrossRefGoogle Scholar
  15. 15.
    Gregory RP, Smith PT, Rudge P. Tardive dyskinesia presenting as severe dysphagia. J Neurol Neurosurg Psychiatry. 1992;55:1203–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Hayashi T, Nishikawa T, Koga I, Uchida Y, Yamawaki S. Life-threatening dysphagia following prolonged neuroleptic therapy. Clin Neuropharmacol. 1997;20:77–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Aino I, Saigusa H, Nakamura T, Matsuoka C, Komachi T, Kokawa T. Progressive dysphagia with peculiar laryngeal movement induced by tardive dystonia. Nihon Jibiinkoka Gakkai Kaiho. 2006;109:786–8.CrossRefGoogle Scholar
  18. 18.
    Agarwal PA, Ichaporia NR. Lupenthixol-induced tardive dystonia presenting as severe dysphagia. Neurol India. 2010;58:784–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Duggal HS, Mendhekar DN. Risperidone-induced tardive pharyngeal dystonia presenting with persistent dysphagia: a case report. J Clin Psychiatry. 2008;10:161–2.Google Scholar
  20. 20.
    Kasantikul D. Drug-induced akathisia and suicidal tendencies in psychotic patients. J Med Assoc Thai. 1998;81:551–3.PubMedGoogle Scholar
  21. 21.
    Ayd Jr FJ. Akathisia and suicide: fact or myth? Int Drug Ther Newsl. 1988;23:37–9.Google Scholar
  22. 22.
    Yassa R, Jones BD. Complications of tardive dyskinesia: a review. Psychosomatics. 1985;26:305–13.PubMedCrossRefGoogle Scholar
  23. 23.
    Wright MT. Antiemetics, akathisia, and pregnancy. Psychosomatics. 2007;48:461–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Hashimoto T, Naiot K, Kitazawa K, Imai S, Goto T. Pallidotomy for severe tardive jaw-opening dystonia. Stereotact Funct Neurosurg. 2010;88:105–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Esper CD, Freeman A, Factor SA. Lingual protrusion dystonia: frequency, etiology and botulinum toxin therapy. Parkinsonism Relat Disord. 2010;16:438–41.PubMedCrossRefGoogle Scholar
  26. 26.
    Schneider SA, Udani V, Sankhla CS, Bhatia KP. Recurrent acute dystonic reaction and oculogyric crisis despite withdrawal of dopamine receptor blocking drugs. Mov Disord. 2009;24:1226–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Szymanski S, Lieberman JA, Safferman A, Galkowski B. Rib fractures as an unusual complication of severe tardive dystonia. J Clin Psychiatry. 1993;54:160.PubMedGoogle Scholar
  28. 28.
    Leung C, Chung DW, Kam IW, Wat KH. Multiple rib fractures secondary to severe tardive dystonia and respiratory dyskinesia. J Clin Psychiatry. 2000;61:215–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Lazarus AL, Toglia JU. Fatal myoglobinuric renal failure in a patient with tardive dyskinesia. Neurology. 1985;35:1055–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Sacks OW, Kohl M. L-dopa and oculogyric crises. Lancet. 1970;2:215–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Yoshida I, Sakaguchi Y, Matsuishi T, et al. Acute accidental overdosage of haloperidol in children. Acta Paediatr. 1993;82:877–80.PubMedGoogle Scholar
  32. 32.
    Burke RE, Reches A, Traub MM, Ilson J, Swash M, Fahn S. Tetrabenazine induces acute dystonic reactions. Ann Neurol. 1985;17:200–2.PubMedCrossRefGoogle Scholar
  33. 33.
    Reeves AL, So EL, Sharbrough FW, Krahn LE. Movement disorders associated with the use of gabapentin. Epilepsia. 1996;37:988–90.PubMedCrossRefGoogle Scholar
  34. 34.
    Shafir Y, Levy Y, Ben-Amital D, Nitzan M, Stenherz R. Oculogyric crisis due to domperidone therapy. Helv Paediatr Acta. 1985;40:95.Google Scholar
  35. 35.
    Gorman M, Barkely GL. Oculogyric crisis induced by carbamazepine. Epilepsia. 1995;36:1158–60.PubMedCrossRefGoogle Scholar
  36. 36.
    Veerapandiyan A, Gallentine WB, Winchester SA, Baker J, Kansagra SM, Mikati MA. Oculogyric crises secondary to lamotrigine overdosage. Epilepsia. 2011;52:e4–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Fraunfelder FW, Fraunfelder FT. Oculogyric crisis in patients taking cetirizine. Am J Ophthalmol. 2004;137:355–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Tahiroglu AY, Avci A. Polypharmacy and EPS in a child; a case report. Psychopharmacol Bull. 2007;40:129–33.PubMedGoogle Scholar
  39. 39.
    Sandyk R. Oculogyric crisis induced by lithium carbonate. Eur Neurol. 1984;23:92–4.PubMedCrossRefGoogle Scholar
  40. 40.
    Lamberti P, de Mari M, Iliceto G, Caldarola M, Serlenga L. Effect of l-dopa on oculogyric crises in a case of dopa-responsive dystonia. Mov Disord. 1993;8:236–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Kakigi R, Shibasaki H, Katafuchi Y, Iyatomi I, Kuroda Y. The syndrome of bilateral paramedian thalamic infarction associated with oculogyric crisis. Clin Neurol. 1986;69:951–3.Google Scholar
  42. 42.
    Della MG, Frisullo G, Vollono C, et al. Oculogyric crisis in a midbrain lesion. Arch Neurol. 2011;68:390–1.CrossRefGoogle Scholar
  43. 43.
    Heimburger RF. Positional oculogyric crises. J Neurosurg. 1988;69:951–3.PubMedCrossRefGoogle Scholar
  44. 44.
    Lee MS, Kim YD, Lyoo CH. Oculogyric crisis as an initial manifestation of Wilson’s disease. Neurology. 1999;52:1714–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Schneider SA, Aggarwal A, Bhatt M, et al. Severe tongue protrusion dystonia: clinical syndromes and possible treatment. Neurology. 2006;67:940–3.PubMedCrossRefGoogle Scholar
  46. 46.
    Horiguchi J, Inami Y. Effect of clonazepam on neuroleptic-induced oculogyric crisis. Acta Psychiatr Scand. 1989;80:521–3.PubMedCrossRefGoogle Scholar
  47. 47.
    Hennigs JM, Krause E, Botzel K, Wetter TC. Successful treatment of tardive lingual dystonia with botulinum toxin: case report and review of the literature. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32:1167–71.CrossRefGoogle Scholar
  48. 48.
    Burke RE, Kang U, Jankovic J, Miller LG, Fahn S. Tardive akathisia: an analysis of clinical features and response to open therapeutic trials. Mov Disord. 1989;4:157–75.PubMedCrossRefGoogle Scholar
  49. 49.
    Kang UJ, Fahn S. Management of tardive dyskinesia. Ration Drug Ther. 1988;22:1–7.PubMedGoogle Scholar
  50. 50.
    Kang UJ, Burke RE, Fahn S. Natural history and treatment of tardive dystonia. Mov Disord. 1986;1:193–208.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of NeurologyColumbia University Medical CenterNew YorkUSA
  2. 2.Movement Disorders DivisionMount Sinai School of MedicineNew YorkUSA

Personalised recommendations