This case report describes an adolescent female with a complex psychiatric history and Fragile X syndrome who developed an antipsychotic-withdrawal emergent oculogyric crisis (OGC) in approximately 12 hours following reduction in olanzapine dose from 20 mg total daily dose to 5 mg twice daily. The team concluded that the OGC was likely related to olanzapine withdrawal based on the following clinical factors: 1) prior treatment with olanzapine 20 mg for 4 to 5 days/week for several months, without such reaction; 2) proximity of the OGC to the olanzapine dose reduction (within 12 hours); and 3) lack of recurrence with olanzapine dose increase. Additionally, her neurodevelopmental disorder and age were identified as risk factors for an acute dystonic reaction. Published case reports describe withdrawal emergent dystonia, including OGC, following abrupt discontinuation of clozapine in adults. Given structural similarities of clozapine and olanzapine it can be postulated that this phenomenon is based in muscarinic receptor function—specifically, super-sensitized muscarinic receptors may react to excessive acetylcholine upon antipsychotic discontinuation, resulting in muscle motor end plate hyperactivity. Providers caring for pediatric patients with neurodevelopmental disorders should carefully consider risks for withdrawal emergent dystonia, obtain clear medication histories, and consider slow, conservative tapers when discontinuing antipsychotics.

To obtain continuing education credit: 1. Read the article carefully. 2. Read each question and determine the correct answer. 3. Visit PedsCE SM , ce.napnap.org, to complete the online Posttest and evaluation. 4. You must receive 70% correct responses to receive the certificate. 5. Tests will be accepted until October 31, 2021. OBJECTIVES 1. Recognize available medications used to manage cerebral palsy−associated spasticity. 2. Evaluate the pharmacology of and current efficacy and safety data on oral and parenteral medications used to manage spasticity in children with cerebral palsy. 3. Describe practical and patient-specific considerations when choosing between medications used to manage spasticity in children with cerebral palsy. Posttest Questions Contact hours: 1.5 (0.25 Controlled Substance) Passing score: 70% This continuing education activity is administered by the National Association of Pediatric Nurse Practitioners (NAPNAP) as an Agency providing continuing education credit. Individuals who complete this program and earn a 70% or higher score on the Posttest will be awarded 1.5 contact hours, of which 1.5 are Pharmacology CE contact hours and 0.25 are related to Controlled Substance.