High vulnerability to acute dystonic reactions: A case of antipsychotic exposure and uncontrolled seizure activity

Gara L. Coffey, Sheila R. Botts, Jose De Leon

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Antipsychotic-induced extrapyramidal side effects have a negative impact on treatment for mental illness. Acute dystonic reactions are uncomfortable and frightening to the patient, and often lead to early discontinuation of drug therapy and worsened long-term outcome. The lower propensity of the atypical antipsychotic agents to cause extrapyramidal symptoms (EPS) has been associated with multiple benefits, including improved adherence. The authors describe a 57-year-old male patient who was in the treatment refractory unit. This patient exhibited extreme sensitivity to antipsychotic agents, experiencing acute dystonic reactions with quetiapine and olanzapine, in addition to older typical antipsychotic agents. The patient has not experienced acute EPS since therapy with aripiprazole was initiated. Further complicating this patient's course is his unusual sensitivity to experiencing dystonic reactions. We have observed acute dystonias in the absence of antipsychotic treatment and in the context of seizure activity (or paroxysmal dyskinetic activity). The true etiology of the latter dystonic activity has not been completely determined due to the patient's unwillingness to cooperate with invasive testing. None of the gene variations tested (CYP2D6 phenotype, two dopamine D2 receptor variants and one D3 receptor variant) appeared to explain the patient's vulnerability to acute dystonic reactions.

Original languageEnglish
Pages (from-to)770-774
Number of pages5
JournalProgress in Neuro-Psychopharmacology and Biological Psychiatry
Issue number5
StatePublished - Jun 2005

Bibliographical note

Funding Information:
No support was received for this report. Dr. Coffey was a Psychiatry Pharmacy Specialty Resident with the University of Kentucky. She has no financial affiliations to report. Dr. Botts has recently submitted a researcher-initiated proposal to Eli Lilly Research Foundation. During the last two years, Dr. Botts has served as a consultant for Astra-Zeneca, Bristol-Myers-Squibb, Elli Lilly and Janssen Pharmaceutica. During the last two years, Dr. de Leon has been on the advisory board of Bristol-Myers Squibb and AstraZeneca; received researcher-initiated grants from Eli Lilly and Roche Molecular Systems, Inc.; and conducted a lecture supported by Eli Lilly. Dr. de Leon would like to acknowledge the staff of Gragg-2 at Eastern State Hospital who provided excellent care for this very difficult patient. In addition, gratitude is expressed to the hospital laboratory staff and its director Kay Marshall who helped by testing all plasma level samples.


  • Acute dystonic reactions
  • Aripiprazole
  • Extrapyramidal side effects
  • Paroxysmal dyskinetic activity

ASJC Scopus subject areas

  • Pharmacology
  • Biological Psychiatry


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