Premature dyskinesia is a medical term used to describe a fairly common side effect of medications that interfere with dopamine metabolism. Since such drugs are mainly used for the therapy of psychoses, schizophrenias and states of agitation, early dyskinesia is a common side effect especially in psychiatry and neurology. However, antiemetics for vomiting such as MCP or domperidone can also cause premature dyskinesia.
What is premature dyskinesia?
Early dyskinesia refers to a movement disorder that can occur during treatment with antidopaminergic medications such as neuroleptics or antiemetics. In this case, involuntary movements such as twitching of the corner of the mouth, spasms of the gullet, or sitting unsteadiness occur acutely or after a few days of regular use. The side effect can be treated well with anticholinergic infusions.
Causes
Dopamine is an important neurotransmitter in the central nervous system and is necessary for the planning and coordination of movements. In the pathogenesis of Parkinson’s disease, for example, dopamine plays a crucial role; lack of movement and rigidity is the result and a common symptom in Parkinson’s patients. In the case of early dyskinesia, the opposite is basically the case, too much movement, because it can no longer be adequately inhibited or slowed down by the influence of dopamine. Drugs that cause this inhibit the dopamine receptors in the brain. This is sometimes a side effect, but sometimes at the same time its desired effect, since dopamine inhibition can, for example, slow down the triggering of vomiting. Metoclopramide (MCP) and domperidone are such antidopaminergic substances that are used as antiemetics against vomiting. However, because this is often short-term, early dyskinesias are rare with antiemetic therapy. More frequently, they occur as a reaction to the antidopaminergic partial effect of neuroleptics: These substances inhibit the development of delusions and hallucinations by interfering with the metabolism of dopamine but also other neurotransmitters such as acetylcholine, serotonin, or histamine and are therefore used in a variety of psychiatric disorders, but are also very popular for sedation and tranquilization, for example, in intensive care units. The stronger the antipsychotic effect, the stronger the undesirable effect on the motor system: early dyskinesia, tardive dyskinesia and other so-called extrapyramidal motor side effects are the result of long-term use. Older neuroleptics such as chlorpromazine and levomepromazine, haloperidol or melperone are particularly affected. Newer, so-called atypical neuroleptics such as clozapine, olanzapine, or risperidone have been specifically developed, among other things, to have fewer such side effects.
Symptoms, complaints, and signs
Early dyskinesia is associated with various complaints and symptoms. In each case, these have a very negative impact on the quality of life of the affected person and can lead to serious complications. In most cases, early dyskinesia primarily involves involuntary movements and usually chewing movements with the mouth. Inner restlessness can also occur due to early dyskinesia and lead to psychological discomfort. Patients often cannot concentrate properly and also suffer from coordination disorders. If the early dyskinesia is not treated and the triggering medication continues to be taken, cramps in the muscles or shortness of breath may occur. Inflammation in the brain can also occur in the worst case due to premature dyskinesia and reduce the life expectancy of the affected person. However, in some cases, the inflammations also occur in other parts of the body. The severity of the symptoms varies in different people, depending on the medication taken. In most cases, the disease can be treated well by stopping the intake of the drug. Long-term damage usually occurs in this case only if the early dyskinesia is not treated at an early stage.
Diagnosis and progression
“Inhibition of inhibition” (disinhibition, so to speak) in motor centers of the central nervous system causes the symptoms of early dyskinesia: after a few days of continuous use of the drug, gaze spasms, tonic head tilt due to muscle spasms or gullet spasms, and even respiratory distress occur.Furthermore, sitting restlessness (akathisia) is a typical side effect, nesting movements of the hands may occur. The opposite is also possible, a Parkinson-like muscle and movement rigidity. All of these motor symptoms occur involuntarily and may be experienced as agonizing by the affected person because they cannot be controlled. Other possible causes of this symptomatology include neurologic dyskinesia, strychnine poisoning, tetanus, or encephalitis. Nevertheless, the history of medication use usually gives a clear indication regarding the cause and suggests the diagnosis of early dyskinesia. The efficacy of the therapy to be initiated promptly in these circumstances is then the final proof of the diagnosis.
Complications
Early dyskinesia results in a variety of complaints that can place a relatively heavy burden on the daily life of the affected person and significantly reduce the quality of life. Increased movements occur, which in most cases are involuntary. Various regions of the body can be affected by these movements and twitches. The patient also suffers from involuntary movements in the area of the mouth, so that he does not chew independently. As a result, the teeth are injured, so there may be pain and damage in the area of the mouth. Likewise, there is a general feeling of discomfort and inner restlessness. It is not uncommon for the muscles to cramp due to early dyskinesis, and respiratory distress may occur. In the worst case, the patient dies due to the shortness of breath. Furthermore, the disease can cause inflammations all over the body. Especially the brain can be affected by these. Early dyskinesia can be treated well, so that there are no further complications and discomfort. In this case, the treatment is usually carried out with the help of medication. Life expectancy is usually not limited.
When should you see a doctor?
Movement disorders that are not based on overexertion or physical strain should be checked by a doctor. If the complaints persist unabated for several days, this is considered unusual and should be clarified by a doctor. Any misalignment of the head, shoulders or upper body should be presented to a physician. Without correction of the physical changes, the affected person risks permanent damage to the skeletal system. If headaches, spasms, stiffness or other muscle complaints occur throughout the body, it is advisable to consult a physician. Abnormal sensations such as twitching or numbness of the skin should be examined and treated. If the discomfort increases or becomes more intense, a doctor should be consulted immediately. If the patient has been taking neuroleptics for a short time, early dyskinesia may be a side effect of the drug. At the first signs, it is necessary to consult the attending physician in order not to suffer permanent health impairment. In case of inner restlessness or malaise, a doctor should be consulted. If relatives can observe unusual eye movements in the patient or if malfunctions of the eyes occur, a visit to the doctor is necessary. If irregularities of the muscles are noticed during chewing or if the movements of the jaw can no longer be controlled voluntarily, a physician should examine and clarify the complaints.
Treatment and therapy
Early dyskinesia can usually be treated very well with an antidote: The anticholinergic drug biperiden inhibits the generation and conduction of motor impulses in the brain, thus stopping the involuntary movements. Given intravenously as an infusion, the drug should kick in after a few minutes. Otherwise, the infusion can be repeated after half an hour; oral administration as tablets is then also possible and necessary. Another option, especially in the case of contraindications to an anticholinergic, is therapy with benzodiazepines, which are also widely used as sleeping pills or in anesthesia and dampen the brain somewhat overall in the short term.
Outlook and prognosis
Because early dyskinesia is caused in most patients by the administration of medications with an antidopaminergic effect, there is often a regression of existing symptoms after a change in the treatment schedule as well as discontinuation of the medications taken. Often, freedom from symptoms is achieved in these patients.Alternatively, the movement abnormalities are treated by the administration of appropriate antidotes. The prognosis for early dyskinesia is generally favorable, but still depends on the underlying disease and the severity of the impairments. If early dyskinesia has been present for several days, respiratory distress or other complications may occur. Thus, secondary diseases are possible, which lead to a worsening of the health condition. They have a negative impact on the patient’s quality of life and, in the worst case, can contribute to a shortening of life expectancy. Without adequate medical care, patients may experience severe impairment in their ability to cope with everyday life. In addition, inflammation can develop in the brain, which is associated with functional limitations and permanent damage. If sufficient medical treatment takes place, early dyskinesia can be treated well with the available options. The sooner the therapy takes place, the faster the symptoms subside. The risk for lifelong sequelae is also reduced in these cases.
Prevention
Prevention of early dyskinesia is difficult because it is an elementary side effect of the drugs. In principle, of course, they should be prescribed only when absolutely necessary. Careful consideration between effect and possible side effect is necessary in any therapy. In the case of prolonged neuroleptic therapy, education about possible symptoms and their early recognition are then particularly important in order to be able to initiate a countermeasure at an early stage.
Follow-up
In most cases, the options for follow-up care in early dyskinesia are very limited. In this case, the patient usually depends first on direct and medical treatment by a physician to properly and, most importantly, completely treat the symptoms. Self-healing cannot occur in the case of early dyskinesia. The earlier the disease is detected, the better the further course of the disease. In most cases, this disease is treated with the help of medication, and special complications usually do not occur. It is necessary to pay attention to a correct and especially to a regular intake and application of these medications in order to accelerate the healing. In some cases, however, the active substances are introduced into the body through infusions, in which case a stay in a hospital is necessary. In general, care and support from friends and family has a very positive effect on the course of early dyskinesia and can alleviate psychological symptoms. In this context, those affected are often dependent on intensive care. Contact with other sufferers of this disease can also be useful in this regard. It cannot be generally predicted whether early dyskinesia will reduce the life expectancy of the affected person.
Here’s what you can do yourself
Since premature dyskinesia is a side effect of medication, the condition can of course be avoided by being informed about the risks and effects when choosing the medication. Therefore, the respective medications should really only be postponed and taken if the condition cannot be treated otherwise. Especially in the case of long-term use, the doctor should inform the patient about the possible side effects. Self-help options are not available to the patient in this case. Patients are then dependent on taking other medications to alleviate the side effects. However, a physician should always be consulted before taking new medications and before discontinuing medications. In severe cases, premature dyskinesia can also lead to loss of consciousness or respiratory distress. In this case, a hospital should be visited directly or an emergency physician should be called to avoid further complications. Until the emergency physician arrives, the affected person must receive emergency ventilation and be placed in a stable lateral position. In the event of internal agitation, it is advisable to calm the patient. However, medical treatment is still urgently required.
