Medicine & USMLE

Extrapyramidal Symptoms

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Mental Health Drugs
  1. Bupropion
  2. SNRIs
  3. SSRIs
  4. MAOIs
  5. Tricyclic Antidepressants (TCAs)
  6. Extrapyramidal Symptoms (EPS)
  7. Serotonin Syndrome
  8. Neuroleptic Malignant Syndrome (NMS)
  9. Lithium
  10. Lithium Toxicity
  11. Typical Antipsychotics
  12. Atypical Antipsychotics
  13. Trazodone
  14. Buspirone
  15. Mirtazapine
  16. CNS Stimulants
  17. Zolpidem
  18. Benzodiazepines
  19. Barbiturates
  20. Barbiturates (Old)
  21. Benzodiazepines (Old)
  22. Lithium (Old)
  23. Bupropion (Old)
  24. SNRIs (Old)
  25. MAOIs (Old)
  26. Amphetamines (Old)
  27. Typical Antipsychotics (Old)
  28. Atypical Antipsychotics (Old)

Summary

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