Methylphenidate Treatment and Dyskinesia in Children with Attention-Deficit/Hyperactivity Disorder

Abstract

Methylphenidate-treated children with ADHD had more dyskinesia than children in the control group. Dyskinesia did not worsen after a single dose of methylphenidate. Higher dyskinesia scores in the methylphenidate-treated younger age group warrant caution in the methylphenidate treatment of ADHD; however, further studies are needed to clarify the possible causal relationship between dyskinesia and methylphenidate treatment and/or age and/or the disease itself.

Acute Focal Dystonic Reaction After Acute Methylphenidate Treatment in an Adolescent Patient

“…16 Data are scarce about dyskinesia and dystonia due to methylphenidate treatment and generally consist of anecdotal case reports, except for 1 controlled study. 11 To our knowledge, this is the first case report of focal dystonia due to methylphenidate treatment. In this case, dystonic reaction subsided after biperiden and diazepam administration.…”

“…The distinct role of histamine 1 receptors in aggressive behavior has been delineated. 11 In conclusion, although using a highdose typical antipsychotic treatment did not provide any benefit regarding selfmutilation in the described case of choreaacanthocytosis, significant remission was accomplished with quetiapine, which was primarily chosen because of its high 5HT2A/D 2 ratio and safe extrapyramidal adverse effect profile. In addition, quetiapine's high histaminergic receptor-blocking properties could also have contributed to the remarkable improvement seen in this patient.…”

“…[3][4][5] Dyskinetic reactions were also related to metylphenidate in the literature. [6][7][8][9][10][11][12][13][14] Dyskinesia emerged after discontinuation of risperidone and initiation of methylphenidate in a case report. 6 Dyskinesia exacerbated by ongoing stimulant treatment emerged after neuroleptic withdrawal in another case report.…”

Dyskinesia in Treatment-Naive and Stimulant-Treated Children With ADHD

“…In the past few decades, and especially in recent years, an emerging number of case studies concerning the association between stimulant (mostly methylphenidate) treatment and dyskinesias have been reported (Balázs, Besnyő, & Gádoros, 2007; Case & McAndrew, 1974; Gay & Ryan, 1994; Heinrich, 2002; Hollis & Thompson, 2007; Marti, Fattinger, Zimmermann, & Exadaktylos, 2013; Mattson & Calverley, 1968; Mendhekar & Andrade, 2008; Morgan, Winter, & Wooten, 2004; Potter, John, & Coffey, 2012; Sallee, Stiller, Perel, & Everett, 1989; Senecky, Lobel, Diamond, Weitz, & Inbar, 2002; Singh, Singh, & Chusid, 1983; Thiel & Dressler, 1994; Yilmaz et al, 2013; Weiner, Nausieda, & Klawans, 1978; Willemsen & van der Wal, 2008). According to Balázs, Dallos, Keresztény, Czobor, and Gádoros (2011), these case reports can be categorized into two groups. In the first group, studies report cases in which dyskinesia arises many weeks after the first administration of the stimulant, and diminishes only months after the withdrawal of the therapy (Gay & Ryan, 1994; Mattson & Calverley, 1968; Mendhekar & Andrade, 2008; Morgan et al, 2004; Potter et al, 2012; Sallee et al, 1989; Singh et al, 1983; Thiel & Dressler, 1994; Weiner et al, 1978).…”

“…Therefore, it is very important to take into account the base prevalence of dyskinesia in healthy control sample when investigating dyskinesia among treated children. Until now, to our knowledge, only one study systematically investigated the level of dyskinesia in a group of children with ADHD treated with methylphenidate and compared them with a healthy control group of children (Balázs et al, 2011). However, in that study, no treatment-naive children with ADHD were involved; therefore, it is not clear whether the higher level of dyskinesia was due to methylphenidate treatment or to an inherent characteristic of ADHD.…”