Tardive oculogyric crisis during treatment with clozapine: Report of three cases
Clinical Drug Investigation, cilt.27, sa.12, ss.861-864, 2007 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 27 Sayı: 12
- Basım Tarihi: 2007
- Doi Numarası: 10.2165/00044011-200727120-00009
- Dergi Adı: Clinical Drug Investigation
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.861-864
- Anahtar Kelimeler: Clozapine, adverse reactions, Eye movement disorders, Schizophrenia, Tardive dyskinesia
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Tardive oculogyric crisis (OGC) is a dystonic syndrome that starts after long-term use of dopamine receptor antagonists. Atypical antipsychotics have reduced liability for inducing tardive dystonia and show antidystonic properties in patients with pre-existing tardive dystonia. Clozapine is an atypical antipsychotic drug, and there have been case reports that clozapine may be an effective treatment for tardive dystonia. Surprisingly, we found that three patients appeared to develop tardive OGC while taking clozapine. The relationship between tardive OGC and clozapine is still unknown. However, it is possible that the previous antipsychotic exposure could have created a sensitising or priming effect on the striatum. Also, there are some suggestions of an underlying susceptibility and possibly a genetic predisposition, at least in some patients. © 2007 Adis Data Information BV. All rights reserved. Results:Case 1: Leponex effectively controlled the patient's psychosis and remained on this treatment exclusively for 2 years. She began to develop OGC, possibly induced by Leponex. She reported feeling of fear and restlessness before the onset of OGC. Case 2: After 6 months of Leponex treatment she began to experience OGC accompanied by fear and restlessness. Case 3: Leponex successfully controlled the patient's psychosis and remained her exclusive antipsychotic treatment for a year. After that she began to experience OGC. In all cases, the OGC attacks were resistant to biperiden. However, OGC spontaneously remitted after 3-5 hours and recurred within 3-7 days. All patients continued taking Leponex. Liver and kidney function, serum ceruloplasmin and thyroid function were all normal in the 3 patients. AdverseEffects:3 patients had oculogyric crisis with feelings of fear and restlessness. FreeText:Case 1 had schizophrenia since she was 15 years old. She began receiving typical antipsychotic agents in 1980 without significant improvement and had been experiencing extrapyramidal adverse effects. Breakthrough psychosis developed in 1999. Her medication was then switched to Leponex. Case 2 was diagnosed with schizophrenia at 15 years of age. Since 1999, she had been receiving olanzapine without significant improvement. She had not experienced extrapyramidal adverse effects. In 2000, olanzapine was switched to Leponex because of resistance. Case 3 was diagnosed with schizophrenia at 25 years of age. Since 1984, she had been receiving haloperidol and sulpiride with little improvement. She experienced extrapyramidal adverse effects with haloperidol. She was switched to Leponex in 2001. Tests: liver and kidney function, serum ceruloplasmin, thyroid function. AuthorsConclusions:Given the rarity of these reports, it would be reasonable to conclude that the incidence of tardive dystonia in clozapine-treated patients will be low. Reporting of similar cases will hopefully lead to a more accurate understanding of the incidence of this potential adverse effect of clozapine therapy. Indications:3 patients with refractory schizophrenia. Patients:3 female outpatients aged 38 (case 1), 19 (case 2) and 45 years (case 3). TypeofStudy:Three cases of tardive oculogyric crisis (OGC) possibly associated with Leponex monotherapy in patients with schizophrenia were reported. DosageDuration:Dosage not stated. Duration was more than 2 years in case 1, 6 months in case 2 and 1 year in case 3.