Olanzapine

Abstract

Oculogyric crisis: case reportA 15-year-old boy developed oculogyric crisis while receiving olanzapine for attention-deficit/hyperactivity disorder. The boy, who had a history of mild mental retardation, epilepsy and attention-deficit/hyperactivity disorder was admitted in an outpatient clinic with symptoms of mobility and anger attacks. When he became angry, he had behavioral issues like banging on doors and throwing items, and his mobility was increased. Previously, he received haloperidol, aripiprazole, risperidone, quetiapine and amisulpride. But the treatment did not benefit him and he also developed aripiprazole and haloperidol attributed neck stiffness. He also received methylphenidate and atomoxetine for the attention-deficit/hyperactivity disorder. However, he did not benefit from the treatment. During the presentation, he was receiving valproic acid for epilepsy. He started receiving olanzapine 2.5 mg/d [route not stated]. Three days later, the olanzapine dose was increased to 2.5mg twice a day. Slight improvement was noted from the day 01 of the treatment. Four days following the start of the treatment, he developed involuntary upward looking and an inability to look down and forward. Pupils were slid up, only their sclera was visible and the pupils were disappeared completely. He was admitted in an emergency department with the symptoms. No abnormality was detected in blood tests and brain imaging. He was suspected to have olanzapine related oculogyric crisis. He had a score of 5 on Naranjo adverse drug reaction probability scale.The boy immediately discontinued the olanzapine treatment and he started receiving biperiden. His symptom of eyes crossing upward completely resolved and then did not recur.