Abstract

Objectives: The aim of the present study is to understand the main pharmacologic triggers for drug induced dystonia (DID), the most common clinical manifestations, and the need for specific treatment.
Methods: We performed a cross-sectional study at the emergency paediatric department of a level II Portuguese hospital and reviewed all clinical records of children who were discharged from our emergency department (ED) with the diagnosis of DID in a 10-years period (2011-2020). The following data were studied: gender, age, trigger for dystonic reaction, type of dystonic reaction, pharmacological approach to reverse the dystonic effects and need of hospital admission. The study protocol was approved by our hospital ethics committee.
Results: We obtained a total of seven patients with a median age of 15 years old. Four patients (57.1%) presented the dystonic reaction after the administration of risperidone. Two patients (28.5%) presented the DID after the administration of a correct dose of haloperidol and one (14.2%) patient after the administration of metoclopramide in a correct dose. Three patients (42.8%) had generalized dystonia (in at least two different body sites), while the remaining four patients (57.1%) presented a focal DID. The most frequent clinical presentation (57.1%) was a buccolingual crisis that included persistent tongue protrusion, tongue fasciculations, tongue deviation, pain, and paralysis. Five patients (71.5%) were treated with intravenous biperiden at the emergency department with clinical resolution. Two patients (28.5%) had an initial spontaneous resolution of the dystonic reaction, but with a recurrence within hours, leading to biperiden treatment as well.
Conclusion: Although drug-induced dystonia is rare among the paediatric population, its occurrence often causes anxiety or pain. Close communication is essential to the early recognition and treatment of DID, avoiding unnecessary investigations for this potentially reversible condition.

Keywords: Acute dystonic reactions; Drug induced dystonia; Antipsychotics; Adverse reactions