Extrapyramidal side effects refer to reactions that patients may experience when taking antipsychotic or dopamine-blocking medications. The disorders include akathisia, dystonia, pseudoparkinsonism and tardive dyskinesia. Symptoms of the disorders range from mild discomfort to permanent involuntary muscle movements. Reactions may begin after a single dose of a medication or they may develop and progress over time as treatment continues.
Akathisia
The term refers to one of the most common extrapyramidal side effects. The disorder may have subjective or objective symptoms. Patients typically complain of feeling restless, having sleep pattern disruptions or having difficulty concentrating. Obvious signs of restlessness include continual foot-tapping, marching, pacing or shuffling. Patients might also rock back and forth while sitting or standing. Other symptoms include continually shifting body weight from one leg to another.
Dystonia
Dystonic side effects are seen as involuntary muscle contractions involving the head, neck, torso or the extremities. Muscles of the head and neck most often affected include the face, eyes, jaw, throat and tongue. Symptoms involving the face and eyes may appear as a facial tic, obsessive blinking or rolling of the eyes. An oculogyric crisis occurs when the eyes roll upward and lock in that position. Symptoms involving the tongue and throat may affect the vocal cords, which causes vocal hoarseness, a stiffened or thick tongue. Individuals may have difficulty speaking, have pharyngeal spasms or a possible obstruction, which entails an emergency situation. Neck and torso symptoms include involuntary tilting of the head, spinal twisting or severe back arching.
Pseudoparkinsonism
The disorder causes physical symptoms that are often associated with Parkinson's disease. Individuals may exhibit pill-rolling with their fingers, have a mask-like facial expression or have a weakened speaking voice. Their arms remain still when walking and they might appear stooped forward. Patients might walk with a shuffle or have a rachet-like movement when extending their arms. Additional facial symptoms may include what is known as rabbit syndrome, which involves continuous movement of the lips and chewing motions. Cognitive symptoms are referred to as bradyphrenia and involve impaired think ability.
Tardive Dyskinesia
The symptoms involve quick, repetitive and involuntary movements of the face, torso, extremities and breathing muscles. Facial movements include a continual protruding or rolling of the tongue, lip smacking, puckering or sucking motions. Patients may also habitually frown, grimace, or exhibit other facial distortions. The arms or legs exhibit abnormal, quick and purposeless movements or slow movements that resemble a serpent. The torso may rock back and forth, jerk, thrust forward or twist.
Symptomatic Management
Symptoms usually subside once the patient stops taking the medication. Sometimes lowering the dose remedies the effects. Akathisia symptoms respond when the antipsychotic medication is discontinued and the patient receives a prescription for an anti-anxiety medication. Dystonia responds to anticholinergic or antiparkinson pharmaceuticals. Patients susceptible to tardive dykinesia should be monitored closely.
