Medication-Induced Movement Disorders and Other Adverse Effects of Medication

Medication-Induced Movement Disorders and Other Adverse Effects of Medication

Have you ever experienced a sudden, involuntary movement that seemed completely out of your control? Many older persons may have felt this unsettling symptom, often unaware that it could be a side effect of their medication. Medication-induced movement disorders (MIMDs) are a common concern among older adults, affecting their quality of life and overall well-being.

In recent discussions, we’ve explored crucial topics like “Neurodevelopmental Disorders in Retirement: Navigating Life’s Later Stages” and “Understanding Compulsive and Stressor-Related Disorders in Retirement“. These posts highlighted the unique challenges faced by retirees, especially in managing mental health. 

Today, we’ll delve deeper into the specific challenges posed by MIMDs, providing valuable insights into their causes.

By the end of this blog post, you’ll have a better understanding of how certain medications can trigger movement disorders and learn about the steps you can take to mitigate their impact. We’ll also discuss other adverse effects of medication that may affect older South Africans, ensuring you have a comprehensive overview of potential risks and preventive measures.

Neuroleptic-Induced Parkinsonism

Neuroleptic-induced Parkinsonism (NIP) is a movement disorder that can occur as a side effect of certain medications, particularly antipsychotic drugs used to treat conditions such as schizophrenia, bipolar disorder, or delusions. It is characterised by symptoms similar to those seen in idiopathic Parkinson’s disease, but it is typically reversible with the discontinuation or adjustment of the offending medication.

Symptoms and Characteristics

The primary symptoms of NIP include:

• Tremor: Shaking or trembling of the hands, arms, legs, or face.
• Rigidity: Stiffness or resistance to movement in the muscles.
• Bradykinesia: Slowness of movement or difficulty initiating movements.
• Postural instability: Difficulty maintaining balance and coordination.

These symptoms can significantly impact a person’s daily activities and quality of life.

Risk Factors

Several factors can increase the risk of developing NIP:

• Medication: Antipsychotic drugs, particularly those with a high dopamine-blocking effect, are the primary risk factors.
• Dose: Higher doses of antipsychotics are more likely to cause NIP.
• Duration of use: Prolonged use of antipsychotics may increase the risk.
• Individual susceptibility: Some individuals may be more genetically predisposed to developing NIP.

Potential Treatments

Treatment for NIP involves reducing or discontinuing the neuroleptic medication, under medical supervision, as abrupt withdrawal can cause serious side effects. In some cases, switching to a different class of antipsychotic medications that have a lower risk of inducing Parkinsonism may be recommended. Medications like anticholinergics and amantadine are sometimes used to alleviate symptoms, although their effectiveness can vary.

If NIP is suspected, it is important to consult with a healthcare professional to determine the appropriate course of action. Treatment options may include:

• Medication adjustment: Reducing the dose or switching to a different antipsychotic medication.
• Antiparkinsonian drugs: Medications used to treat Parkinson’s disease, such as levodopa or dopamine agonists, can help alleviate symptoms.
• Physical therapy: Exercises and physical therapy can help improve mobility and function.

Other Medications Inducing Parkinsonism-Like Symptoms

While antipsychotic drugs are the most common cause of NIP, other medications can also induce Parkinsonism-like symptoms. These include:

• Antidepressants: Some antidepressants, particularly atypical antidepressants, can cause tremors or rigidity.
• Antiemetics: Medications used to treat nausea and vomiting, such as prochlorperazine or metoclopramide, can have Parkinsonian side effects.
• Antihistamines: Certain antihistamines, especially older-generation ones, may induce tremors or rigidity.

It is important to be aware of these potential side effects and discuss any concerns with your healthcare provider.

Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening condition that can occur as a side effect of antipsychotic medications. It is characterized by a combination of muscle rigidity, fever, altered mental status, and autonomic dysfunction.

Symptoms and Severity

The symptoms of NMS can be severe and include:

• Muscle rigidity: Stiffness or tightness in the muscles, particularly in the limbs and trunk.
• Fever: Elevated body temperature.
• Altered mental status: Confusion, agitation, or coma.
• Autonomic dysfunction: Symptoms such as high blood pressure, rapid heart rate, sweating, and difficulty swallowing.

NMS can rapidly deteriorate and lead to serious complications, including respiratory failure, kidney failure, and even death.

Medical Emergency and Management

NMS is a medical emergency that requires immediate attention. If you or someone you know experiences symptoms of NMS, it is essential to seek medical help immediately.

The management of NMS involves supportive care and discontinuation of the offending medication. Treatment may include:

• Hydration: Intravenous fluids to maintain hydration and electrolyte balance.
• Cooling measures: Medications or cooling blankets to reduce fever.
• Muscle relaxants: Medications to help relax the muscles and reduce rigidity.
• Dopamine agonists: Medications that can help alleviate symptoms and promote recovery.
• Intensive care monitoring: Close monitoring of vital signs, respiratory function, and electrolyte levels.

Given the high risk of complications, early recognition of NMS is critical. Healthcare providers must act swiftly to manage the condition and prevent long-term consequences. The patient’s recovery can be prolonged, and in severe cases, NMS can lead to significant morbidity or even death if not promptly treated.

Medication-Induced Acute Dystonia

Acute dystonia is a sudden, involuntary muscle contraction that can cause twisting or contorting of the body parts. It is a common side effect of certain medications, particularly antipsychotic drugs.

Common Manifestations

Acute dystonia can affect various parts of the body, but common manifestations include:

• Oculogyric crisis: Involuntary upward rolling of the eyes.
• Torticollis: Twisting of the neck to one side.
• Laryngeal dystonia: Difficulty swallowing or breathing due to muscle spasms in the throat.
• Blepharospasm: Involuntary closing of the eyes.

These symptoms can be painful, distressing, and interfere with daily activities.

Treatment Options

Acute dystonia is a medical emergency that requires immediate treatment. The most effective treatment is the administration of an anticholinergic medication, such as benztropine or diphenhydramine. These medications help to relax the muscles and reverse the dystonic symptoms.

In severe cases, intravenous benzodiazepines or muscle relaxants may be used to control the symptoms.

Difference Between Acute Dystonia and Tardive Dyskinesia/Dystonia

While both acute dystonia and tardive dyskinesia/dystonia involve involuntary movements, there are key differences between them:

• Onset: Acute dystonia occurs suddenly and typically soon after the initiation or increase of certain medications, while tardive dyskinesia/dystonia develops gradually, often after prolonged use of neuroleptic drugs.
• Duration: Acute dystonia is usually short-lived and responds well to treatment, whereas tardive dyskinesia/dystonia can be persistent and difficult to treat, often continuing even after the causative medication is discontinued.
• Movement Patterns: Acute dystonia often involves sustained muscle contractions leading to twisting movements or abnormal postures. In contrast, tardive dyskinesia typically presents with repetitive, rhythmic movements, particularly of the face and mouth, and tardive dystonia may involve more sustained and repetitive muscle contractions similar to acute dystonia but with a delayed onset.

It is important to differentiate between acute dystonia and TD/TD as the treatment approaches are different. Early recognition and management of acute dystonia can help prevent the development of more chronic movement disorders.

Tardive dyskinesia, like tardive dystonia, emerges following several years of use of antipsychotic medication. Reported rates of acute dystonias among older patients treated with neuroleptics are between 1.5 and 2.0 %, as opposed to rates 10 to 15 times higher among younger individuals.

Tardive Dyskinesia and Tardive Dystonia

Tardive dyskinesia (TD) and tardive dystonia are chronic movement disorders that can develop as a side effect of long-term use of certain medications, particularly antipsychotics. They are characterized by involuntary, repetitive movements of the face, tongue, limbs, or trunk.

Risk Factors

Several factors can increase the risk of developing TD and TD:

• Medication: Antipsychotic drugs, particularly older-generation ones, are the primary risk factor.
• Duration of use: Prolonged use of antipsychotics increases the risk.
• Dosage: Higher doses may increase the risk.
• Individual susceptibility: Some individuals may be more genetically predisposed to developing TD or TD.

Symptoms

TD and TD can manifest in various ways, but common symptoms include:

• Facial movements: Grimacing, tongue protrusion, lip smacking, or chewing movements.
• Limb movements: Writhing, twisting, or involuntary jerking of the arms or legs.
• Trunk movements: Rocking, twisting, or swaying of the body.
• Dystonia: Sustained muscle contractions that can cause twisting or contorting of body parts.

Treatment Options

There is no cure for TD or TD, but treatment can help manage symptoms and improve quality of life. Treatment options may include:

• Medication adjustment: Reducing the dose or switching to a different medication.
• Antiparkinsonian drugs: Medications used to treat Parkinson’s disease may help alleviate symptoms.
• Botulinum toxin injections: Injections of botulinum toxin can help relax the muscles and reduce involuntary movements.
• Deep brain stimulation: A surgical procedure that involves implanting electrodes in the brain to regulate abnormal electrical activity.

Importance of Early Detection and Prevention

Early detection and prevention of TD and TD are crucial. Regular monitoring for signs of movement disorders is essential for individuals taking antipsychotic medications. If symptoms of TD or TD are noticed, it is important to consult with a healthcare professional to discuss treatment options and explore ways to minimize the risk of progression.

Medication-Induced Acute Akathisia and Tardive Akathisia

Akathisia is a movement disorder characterized by a sense of restlessness and an inability to sit still. It can be induced by certain medications, particularly antipsychotics. There are two main types of akathisia: acute akathisia and tardive akathisia.

Acute Akathisia

Acute akathisia typically occurs within the first few days or weeks of starting a medication. It is characterized by:

• Restlessness: An urge to move constantly, often accompanied by feelings of anxiety or agitation.
• Pacing: Difficulty sitting still and a tendency to pace or fidget.
• Inner tension: A sense of internal restlessness or unease.

Tardive Akathisia

Tardive akathisia is a more chronic form of akathisia that develops after prolonged use of certain medications. It is characterized by similar symptoms to acute akathisia, but it can be more persistent and difficult to treat.

Symptoms

The symptoms of akathisia can be distressing and interfere with daily activities. In addition to restlessness and pacing, individuals may experience:

• Insomnia: Difficulty sleeping due to the inability to sit still.
• Irritability: Increased irritability or mood swings.
• Anxiety or depression: Feelings of anxiety or depression can accompany akathisia.

Treatment Options

The treatment of akathisia often involves adjusting the medication that is causing the symptoms. This may involve reducing the dose, switching to a different medication, or discontinuing the medication altogether.

In some cases, medications specifically used to treat akathisia, such as beta-blockers or benzodiazepines, may be prescribed. However, it is important to use these medications with caution, as they can have their own side effects.

Management Strategies

In addition to medication, several management strategies can help individuals with akathisia cope with their symptoms:

• Exercise: Regular physical activity can help alleviate restlessness and improve mood.
• Relaxation techniques: Techniques such as deep breathing, meditation, or yoga can help reduce anxiety and stress.
• Cognitive-behavioral therapy (CBT): CBT can help individuals develop coping strategies for the psychological symptoms associated with akathisia.
• Support groups: Connecting with others who have experienced akathisia can provide emotional support and practical advice.

It is important to work closely with a healthcare professional to develop a personalized treatment plan that addresses both the physical and psychological aspects of akathisia.

Medication-Induced Postural Tremor

Medication-induced postural tremor is a type of tremor that occurs when a person attempts to maintain a position against gravity, such as holding their arms outstretched. It is characterised by rhythmic, involuntary shaking that is most noticeable when the affected muscles are actively engaged. Unlike resting tremors, which occur when the muscles are relaxed, postural tremors are triggered by sustained muscle contraction. 

These tremors can vary in intensity, ranging from mild and barely noticeable to severe and debilitating, significantly impacting daily activities.

Patients experiencing medication-induced postural tremors may find tasks that require steady hands, such as writing, eating, or holding objects, particularly challenging. The tremor typically ceases when the affected limb is at rest, distinguishing it from other forms of tremor associated with different neurological conditions.

Potential Causes of Medication-Induced Postural Tremor:

Medication-induced postural tremor is commonly associated with several types of medications, particularly those that affect the central nervous system. The following are some potential causes:

• Beta-adrenergic agonists: Medications such as salbutamol, often used in the treatment of asthma, can cause tremors as a side effect due to their stimulatory effects on the nervous system.
• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are known to induce tremors in some patients, particularly at higher doses or when combined with other central nervous system-active drugs.
• Lithium: Commonly used in the management of bipolar disorder, lithium is another medication that can lead to the development of postural tremors. This side effect is often dose-dependent and can become more pronounced with higher lithium levels.
• Antipsychotics: Some antipsychotic medications, particularly older typical antipsychotics, can induce extrapyramidal symptoms, including postural tremors. These are often related to the dopamine-blocking effects of the drugs.

Management Strategies

Medication Adjustment: The first step in managing medication-induced postural tremor involves reviewing the patient’s current medications. If a particular drug is identified as the cause, the healthcare provider may consider lowering the dosage or switching to an alternative medication with a lower risk of tremors. This adjustment should always be done under medical supervision to ensure the underlying condition is still effectively managed.

Beta-Blockers: Beta-blockers, such as propranolol, are commonly prescribed to manage postural tremors. These medications work by blocking the effects of adrenaline on the nervous system, thereby reducing the tremor’s intensity. Beta-blockers are particularly effective in cases where the tremor is linked to beta-adrenergic agonist medications or stress.

Anticonvulsants: Medications like primidone or gabapentin, traditionally used to manage seizures, can also be effective in reducing postural tremors. These drugs work by stabilising neuronal activity, which can help to lessen the severity of the tremor.

Lifestyle Modifications: Patients may benefit from certain lifestyle changes that can help reduce the impact of tremors. This includes reducing caffeine intake, as caffeine can exacerbate tremors, and engaging in relaxation techniques such as yoga or meditation to manage stress, which can trigger or worsen tremors.

Physical and Occupational Therapy: Engaging in physical therapy can help strengthen muscles and improve coordination, potentially reducing the impact of tremors. Occupational therapy can provide strategies and tools to help patients adapt their daily activities to better manage their symptoms.

Regular Monitoring: Ongoing monitoring of the patient’s condition is essential to assess the effectiveness of the management strategies and to make further adjustments as needed. This may involve regular follow-ups with a healthcare provider to ensure that the tremor remains well-controlled.

By understanding the characteristics and causes of medication-induced postural tremor, and employing effective management strategies, patients and healthcare providers can work together to minimise the impact of this condition on the patient’s quality of life.

Other Medication-Induced Movement Disorders

While the movement disorders discussed thus far are among the most common, there are several other less frequent MIMDs that can affect individuals.

Medication-induced myoclonus is characterized by brief, involuntary muscle jerks. It can be caused by a variety of medications, including antidepressants, anticonvulsants, and antipsychotics.

Medication-induced chorea is a movement disorder characterized by rapid, irregular, and involuntary movements of the limbs and facial muscles. It can be caused by medications such as levodopa, used in the treatment of Parkinson’s disease, or certain antipsychotics.

Challenges in Diagnosis and Treatment

Diagnosing these less common MIMDs can be challenging, as they may mimic other neurological conditions or present with atypical symptoms. A thorough medical history and physical examination, along with potential neuroimaging studies, may be necessary to establish a diagnosis.

Treatment for these conditions often involves discontinuation or adjustment of the offending medication, as well as symptomatic management. However, in some cases, it may be difficult to identify the exact cause of the movement disorder, making treatment more complex. Additionally, these conditions can sometimes be refractory to treatment, leading to ongoing challenges for patients and healthcare providers.

Antidepressant Discontinuation Syndrome

Antidepressant discontinuation syndrome (ADS) is a set of symptoms that can occur when antidepressant medication is abruptly stopped or the dosage is reduced too rapidly. It is a common condition that can affect individuals who have been taking antidepressants for several weeks or longer.

Symptoms

The symptoms of ADS can vary widely, but they often include:

• Flu-like symptoms: Fatigue, muscle aches, headache, nausea, and chills.
• Mood changes: Anxiety, irritability, sadness, or difficulty concentrating.
• Sleep disturbances: Insomnia, vivid dreams, or nightmares.
• Sensory disturbances: Dizziness, lightheadedness, or electric shock-like sensations.
• Gastrointestinal symptoms: Diarrhea, constipation, or loss of appetite.

Risk Factors

Several factors can increase the risk of developing ADS:

• Medication type: Certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are more likely to cause ADS.
• Duration of treatment: Longer duration of treatment increases the risk.
• High dosage: Higher doses of antidepressants may increase the risk.
• Abrupt discontinuation: Stopping the medication abruptly, rather than tapering off gradually, significantly increases the risk.

Prevention Strategies

To prevent ADS, it is important to taper off antidepressants gradually under the guidance of a healthcare professional. This involves gradually reducing the dosage over several weeks or months, allowing the body to adjust to the decreased levels of the medication.

Other Adverse Effects of Medication

In addition to ADS, medications can have other potential adverse effects, including:

• Allergic reactions: Some individuals may develop allergic reactions to certain medications, which can range from mild skin rashes to severe anaphylaxis.
• Hepatotoxicity: Some medications can damage the liver, leading to conditions such as hepatitis or liver failure.
• Renal impairment: Certain medications can affect kidney function, potentially leading to kidney damage or failure.

It is important to be aware of these potential risks and discuss any concerns with your healthcare provider. Regular monitoring of liver and kidney function may be necessary for individuals taking certain medications.

By understanding the potential adverse effects of medications and taking appropriate precautions, individuals can minimize their risks and ensure their overall well-being.

Conclusion

Medication-induced movement disorders (MIMDs) can significantly impact the quality of life for older people. Understanding the various types of MIMDs, their symptoms, and potential causes is essential for early detection and effective management. By working closely with healthcare providers and being aware of the potential risks associated with certain medications, individuals can take proactive steps to minimize the impact of these conditions.

We appreciate you taking the time to learn about medication-induced movement disorders. Remember, if you or a loved one is experiencing any unusual symptoms, it’s important to consult with a healthcare professional for proper evaluation and treatment.

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