奥氮平所致难治性迟发性肌张力障碍1例（英文）

迟发性肌张力障碍是长期使用抗精神病药物所致的一系列锥体外系症状,主要特征包括骨骼肌肉(随意肌)自主运动困难和随后的躯体变形。迟发性肌张力障碍在服用奥氮平患者中罕见,但本文报道中奥氮平正是这名22岁男性精神分裂症患者的促发抗精神病药物,他坚持服用标准剂量的奥氮平大约1年后出现撅嘴、持续不自主斜颈、肌肉疼痛、轴向肌张力障碍和步态不稳的症状。停用奥氮平后,他的症状没有缓解。氯氮平合并丙戊酸镁、维生素E、硫必利和劳拉西泮治疗四个月也没有让肌张力障碍得到任何改善。     

Treatment of generalized tardive dystonia with clozapine

Tardive dystonia is a syndrome of sustained muscle contractions, frequently causing twisting and repetitive movements or abnormal postures, associated with prolonged exposure to antipsychotics. We report a case of a 35-year-old patient with schizophrenia who developed a generalized form of tardive dystonia after switching of clozapine to risperidone treatment that persisted after switch to olanzapine and during the period while treatment with an antipsychotic was discontinued. It was successfully managed with reintroduction of clozapine. The case may represent the first report of generalized tardive dystonia while taking risperidone. The possible pathophysiological bases of the disorder are discussed. The goal of our report is to emphasize that an adequate trial of clozapine is a worthwhile option in the cases of tardive dystonia, even where discontinuation of antipsychotics was unsuccesful.     

Treatment of tardive dystonia with an antispastic agent

Tardive dystonia is a difficult condition to treat. We describe the case of a patient with tardive dystonia that was unresponsive to various pharmacological and electroconvulsive therapies. The patient showed dramatic improvement after the administration of eperisone, a centrally acting muscle relaxant. Eperisone and tolperisone are beta;-aminopropiophenone derivatives which are used clinically as antispastic agents. To date there have been no reports describing the effect of such muscle relaxants on tardive dystonia. The results of our study suggest that these muscle relaxants may be promising therapeutic drugs for the treatment of tardive dystonia.     

Treatment of severe tardive dystonia with pallidal deep brain stimulation

In five patients with medically refractory tardive dystonia, continuous bilateral high-frequency stimulation of the globus pallidus internus was associated with a rapid (within 12 to 72 hours) and substantial (mean 87%, 10.7 SD of the motor part of the Burke-Fahn-Marsden Dystonia Rating Scale) improvement of dystonia and functional disability without adverse events.     

Sulpiride-induced tardive dystonia

Sulpiride is a selective D2-receptor antagonist with antipsychotic and antidepressant properties. Although initially thought to be free of extrapyramidal side effects, sulpiride-induced tardive dyskinesia and parkinsonism have been reported occasionally. We studied a 37-year-old man who developed persistent segmental dystonia within 2 months after starting sulpiride therapy. We could not find any previous reports of sulpiride-induced tardive dystonia.     

Prevalence of tardive dystonia

Tardive dystonia is a rare late-onset side effect of neuroleptics. This paper presents a prevalence study of 351 inpatients conducted in our hospital. Seven patients (2%) were found to suffer from this condition. The majority were found to be young and had received neuroleptics for a variable number of years before the onset of the dystonia. In general, treatment of this condition is disappointing.     

Tardive dystonia associated with olanzapine therapy

A 21-year-old man with the diagnosis of paranoid schizophrenia was admitted to our clinic with cervical dystonia developing at the end of the first year of olanzapine therapy. The present case suggests that tardive dystonia in this patient is most likely associated with olanzapine administration as this is the main antipsychotic he received. Regarding the few case reports of olanzapine-associated tardive syndromes, patients taking olanzapine should be carefully screened for the appearance of tardive movements. Received: 20 March 2001 / Accepted in revised form: 14 September 2001     

The treatment of tardive dyskinesia and tardive dystonia

The enthusiasm produced by the introduction of antipsychotic medication in the 1950s gave way to a certain frustration in the 1970s and 1980s. Despite the development of a large number of new drugs, little progress was made in treatment because these new agents were, in essence, therapeutically equivalent. This lack of progress was perhaps also related to an emphasis on tardive dyskinesia in the 1970s, i.e., the preoccupation with a negative effect of treatment. The reverse is taking place today. Clozapine and the other atypical antipsychotics are associated in people's minds with fewer or absent extrapyramidal symptoms and less tardive dyskinesia than the older typical agents. As a result, a certain amount of complacency exists. Tardive dyskinesia not only may be painful and disfiguring, but it also predicts poor outcome in patients with schizophrenia. Although many treatments have been tried, none have proven completely efficacious. The best treatment for tardive dyskinesia and dystonia is prevention, which is a function of medication choice. Pharmacologic interventions for tardive dyskinesia include clozapine and the other atypical antipsychotics. If typical antipsychotics must be used, they should be started at the lowest possible levels. Studies of risperidone suggest that it, too, should be used at very low doses to minimize the risk of tardive dyskinesia. It is also possible that schizophrenic patients taking atypical antipsychotics may experience fewer spontaneous dyskinesias, although further study is warranted.     

Improvement of tardive dyskinesia after treatment with olanzapine

Tardive dyskinesia is a severe complication of neuroleptic treatment. It may develop weeks, even years after starting a neuroleptic treatment and the symptoms may be irreversible. Neuroleptic compounds are not only used in cases of schizophrenia, but also in cases of severe depression with delusional symptoms. We want to present the case of a 67 year old female patient who developed haloperidol induced dyskinesea and stress unto the successful treatment of this complication with olanzapine in combination with paroxetine. Under this regime not only the improvement of the depression, but also of the tardive dyskinesea was impressive.     

A case of tardive dystonia

Tardive dystonia in a chronic dystonia caused by neuroleptics. A 53-year-old man suffering from a neuroleptic induced dyskinesia began to show an abnormal posture. His abnormal posture was caused by changes of muscle tonus and thought to be a dystonic posture. He had no family history of dystonia. This posture was similar to that of idiopathic dystonia in that the muscle tonus was hypertonic in sitting but was hypotonic in lying, and in that the activity of daily living was not disturbed in spite of hypertonia. But he also showed lingual dyskinesia and hyperreflexia and the electromyographic analysis disclosed the fact that his dystonia was similar to that of secondary dystonia. Brain CT showed the atrophy of the head of caudate nucleus but superconducting MRI disclosed no abnormality in basal ganglia. No effective therapeutics was as yet found in tardive dystonia. So it was proposed that the tardive dystonia was due to irreversible functional damage to the basal ganglia.     

Risk factors for tardive dystonia: a case-control comparison with tardive dyskinesia

The objective of this study was to determine the putative risk factors for the development of tardive dystonia (TDt) in contrast with tardive dyskinesia (TD). Fifteen TDt patients seen in the Movement Disorders Clinic were compared with 2 groups of 15 TD controls each. The first control group was drawn from the Clinic and matched with the TDt cases for severity, using degree of dysfunction as the matching variable. The second control group comprised mild TD cases drawn from a separate study of drug-induced movement disorders in chronic schizophrenia and were matched for age and sex with the TDt cases. A number of demographic, treatment-related, diagnosis-related and historical variables suggested in the literature were examined. Most risk factors for TDt that have been suggested by previous studies were not supported. The first control group was significantly older than the TDt cases. The TDt patients had a more frequent past history of acute drug-induced dystonia and of postural tremor prior to the onset of the mental illness, although only the former reached statistical significance. The results suggested that TDt and TD do not differ in most putative risk factors, although the small sample size increases the likelihood of a type II error. It is inconclusive on the role of young age and male sex as risk factors. TDt cases may, however, be individuals vulnerable to the development of dystonia, with neuroleptics probably bringing out such a vulnerability. This finding needs to be examined in larger studies.     

Lithium - induced tardive dystonia

Tardive dystonia is an uncommon form of chronic dystonia, which usually develops on exposure to neuroleptics. Tardive dystonia (Tdt) following lithium therapy has not been previously reported. The case of 38 year old man with bipolar affective disorder who developed tardive dystonia while on maintenance lithium treatment is described. Presentation of Tdt in this patient was fairly characteristic although there was no suggestion of recent neuroleptic exposure. Tdt known to have poor treatment response, responded very well to clozapine, a novel anti-psychotic, in this case. To conclude, Tdt may develop on exposure to drugs other than neuroleptics. An adequate trial to clozapine can prove to be a useful treatment option.     

Baclofen treatment in a patient with tardive dystonia

The use of baclofen, a structural analog of gamma-aminobutyric acid (GABA), is described in the treatment of a patient with tardive dystonia. The patient, a woman with a clinical diagnosis of Alzheimer's disease, developed tardive dystonia after 8 weeks of haloperidol therapy and experienced complete remission of her dystonia while taking baclofen 60 mg/day. This case suggests that baclofen may facilitate remission of tardive dystonia in some cases and provides a basis for further investigation.     

A comparison of severe tardive dystonia and severe tardive dyskinesia

The authors present a demographic study comparing tardive dystonia with severe tardive dyskinesia (TD) patients. Tardive dystonia was more common among young men, while severe TD was more common in older women. Neuroleptics were distributed equally in both groups before the onset of the movement disorders. Drug-free periods were common in the history of severe TD than in tardive dystonia patients.