Oculogyric crisis with atypical antipsychotics: A case series

Abstract

Oculogyric crisis (OGC) is an acute dystonic reaction, commonly seen with the administration of typical antipsychotics, and rarely reported with atypical antipsychotics. Here, we report five cases of oculogyric crisis, developed after administration of atypical antipsychotics. The first case developed OGC on quetiapine 800 mg/day and the second case on olanzapine 20 mg/day. Both the patients did not improve on adding anticholinergic agents and finally stabilized by switching to clozapine. The third case developed OGC on amisulpride 400 mg and lurasidone 40 mg/day and improved by reducing amisulpride dose to 200 mg and stopping lurasidone. The fourth case developed OGC on aripiprazole 30 mg/day and improved by dose reduction. The fifth case developed OGC on amisulpride 400 mg/day and improved by switching to risperidone and anticholinergic combination. Oculogyric crisis is a potential side effect of antipsychotic medications (mostly with typical and rarely with atypical) and generally respond to oral anticholinergics, but in some cases, dose reduction or discontinuation of antipsychotic agent and switching to safer alternatives or clozapine is required.

Ziprasidone-Induced Oculogyric Crisis in a 74-Year-Old Female

“…Generally, men are more frequently affected [9]. A family history of neurological disease and remote treatment with neuroleptics do put patients at increased risk of OGC [10].…”

Aripiprazole-induced oculogyric crisis (acute dystonia) in 11 years old girl: a case report

“…The reported cases are mostly related to the adult population. 13,15,16 . Our case is important as she is one of the rare cases of aripiprazole-induced oculogyric crisis (acute dystonia) reported to literature in the pediatric age group.…”

“…Antipsychotic agents cause acute dystonia by blocking dopamine D2 receptors in caudate, putamen, and globus pallidum 14 . The possible mechanism for the development of less extrapyramidal side effects result from aripiprazole is that it has partial agonistic activity to dopamine D2 and serotonin 5HT1A receptors and full antagonistic activity to the 5HT2A receptor [15][16][17] . Additionally, the effect of aripiprazole on D3, 5-HT6, and 5-HT7 receptors is still not fully known and may therefore play a role in the oculogyric crisis.…”

“…Navratan et al presented a 19-year-old obsessive-compulsive disorder patient who using fluoxetine 80 mg and aripiprazole 10 mg. On the 5th day of aripiprazole 10 mg, he developed a tightening of the neck muscles with a backward and right-sided deviation of the head along with uprolling of the eyeballs. All symptoms of their case healed, after aripiprazole was stopped, injection promethazine 50 mg intramuscularly was given immediately 16 . In our case, the oculogyric crisis was resolved with biperiden injection as in the case of Fountoulakis et al Extrapyramidal side effects of antipsychotic medication ıt depends on the blockade of striatal D2 receptors and is usually treated with anticholinergic agents such as biperiden 17,20 .…”

Spotlight on Oculogyric Crisis: A Review

“…35 Finally, medications which would increase the risk of developing OGC include various groups such as antipsychotics, antiemetics, anticonvulsants, and antidepressants ( Table 1). Acute dystonic reactions are commonly seen with the use of high-potency typical antipsy-chotics, relatively uncommon with atypical antipsychotics, 36 and rarely reported with clozapine. 37 A few cases of acute dystonic reaction, including OGC, have been associated with anesthetic agents like propofol, sevoflurane, nitrous oxide, and fentanyl administration.…”