Methylphenidate-Induced Acute Orofacial and Extremity Dyskinesia

Abstract

Methylphenidate is a short-acting stimulant. In this article, the authors report a 7-year-old male patient who presented with orofacial and limb dyskinesia after his first dose of methylphenidate treatment for a diagnosis of attention-deficit/hyperactivity disorder; he was also receiving sodium valproate treatment for epilepsy. Orofacial dyskinesia appeared 5 hours after methylphenidate administration, persisted for 10 hours, and had completely resolved within 2 days. Although limb dyskinesia after methylphenidate is a commonly reported side effect, to the authors' knowledge this is only the second reported case to develop both orofacial and limb dyskinesia in the acute period after the first dose of methylphenidate. This case is reported to emphasize the potential side effects of methylphenidate, individual differences in drug sensitivities, and drug-receptor interactions via different mechanisms.

Neurological adverse effects of methylphenidate may be misdiagnosed as meningoencephalitis

“…Five of these children10 12 15 16 were taking concurrent antiepileptics or neuroleptics including valproate (3/10), phenobarbital (1/10) or thioridazine (1/10).…”

Tardive dyskinesia in an 8-year old child

“…The possibility of methylphenidate induced dyskinetic movements (12) or motor tics (13) need to be considered in the differential diagnosis of TD in this child. But the fact that methylphenidate was continued for 2 years at the same dosage without development of any motor symptoms, the inability of the child to suppress the movements despite trying, the increase or persistence of movements at same level on distraction, and the absence of pre-monitory urge or tension makes this possibility less likely.…”

Methylphenidate-Induced Acute Dystonic Reaction: A case report

“…When consulting Embase and PubMed, few case reports describe children with abnormal movements attributable to methylphenidate. In these reports present a case 10-year-old girl under multiple pharmacologic treatment (imipramine, methylphenidate, valproic acid) who developed oculogyric crisis [6] and other case a 7-year-old male patient who presented with orofacial and limb dyskinesia after his first dose of methylphenidate treatment for a diagnosis of attention-deficit/hyperactivity disorder; he was also receiving sodium valproate treatment for epilepsy [7]. But our case differ from others which have mentioned above, in terms of being healthy and exposing only MPH.…”