extrapyramidal symptoms
- "Extrapyramidal" = parts of brain and brainstem that contribute to motor control but not in the corticospinal-pyramidal system
- Basal ganglia
- reticular formation of the brain stem
- vestibular nuclei
- often the red nuclei
causative medications
- chlorpromazine (1st and 2nd gen antipsychotics)
types of EPSE
| Symptom | Timescale | More common in... |
|---|---|---|
| Parkinsonian symptoms | gradually | older people, pre-existing neurological damage |
| Dystonia | within hours | young males |
| Akathisia | Hours to weeks | |
| Tardive dyskinesia | after long-term treatment |
table adapted shamelessly from BNF summary:
- parkinsonian symptoms (including bradykinesia, tremor), which may occur more commonly in elderly females or those with pre-existing neurological damage such as stroke, and may appear gradually;
- dystonia (uncontrolled muscle spasm in any part of the body), which occurs more commonly in young males; acute dystonia can appear within hours of starting antipsychotics;
- akathisia (restlessness), which characteristically occurs within hours to weeks of starting antipsychotic treatment or on dose increase and may be mistaken for psychotic agitation;
- tardive dyskinesia (abnormal involuntary movements of lips, tongue, face, and jaw), which can develop on long-term or high-dose therapy, or even after discontinuation; in some patients it can be irreversible.