Medicine & USMLE

Extrapyramidal Symptoms

Mental Health Drugs
  1. Tricyclic Antidepressants
  2. SSRIs
  3. SNRIs
  4. Benzodiazepines
  5. Barbiturates
  6. Typical Antipsychotics
  7. Atypical Antipsychotics
  8. Extrapyramidal Symptoms
  9. Lithium
  10. MAOIs
  11. Bupropion
  12. Buspirone
  13. Trazodone
  14. Zolpidem
  15. Amphetamines
  16. Mirtazapine


Extrapyramidal symptoms, abbreviated EPS, are a group of neurologic symptoms classically caused by drugs like metoclopramide and antipsychotic medications. The symptoms that make up EPS include: involuntary muscle contractions called dystonia; restlessness and fidgeting called akathisia; shuffling gait, slow movements, and tremors called pseudoparkinsonism; as well as repetitive lip smacking and tongue rolling called tardive dyskinesia. Extrapyramidal symptoms can be treated with anticholinergic agents like benztropine. They will also go away by lowering the dose or stopping the offending medication altogether.

Key Points

  • Extrapyramidal Symptoms (EPS)
    • Causes
      • Antipsychotics
      • Metoclopramide
    • Symptoms
      • Dystonia
        • Sudden onset of sustained muscle contractions, especially of face, neck (torticollis) and trunk (opisthotonos)
      • Akathisia
        • Restlessness, fidgeting or writhing
      • Pseudoparkinsonism
        • Rigidity
        • Bradykinesia (slowness of movement)
        • Tremor
        • Shuffling gait
        • Mask-like face
      • Tardive Dyskinesia (TD)
        • Irregular jerky movements
        • Lip smacking
        • Tongue rolling
    • Treatment
      • Benztropine
        • Other anticholinergic medications (e.g. trihexyphenidyl) may be used
      • Stopping the antipsychotic or lowering the dose