Unprovoked Dystonic Reaction in a Child Taking Long-Term Methylphenidate

Abstract

In this report, we discuss the case of a 9-year-old male with Attention Deficit Hyperactivity Disorder (ADHD) on long-term methylphenidate and guanfacine who experienced acute orofacial dystonia that resolved immediately with the administration of benztropine. Current literature describes various cases of methylphenidate-induced dystonia, but ours appears to be the first reported instance of spontaneous dystonia without a recent change in dose or medication change. This may suggest the possibility of methylphenidate-induced dystonia spontaneously occurring several years after initiation.

Tardive and Acute Dystonic Reactions Probably Related to Extended Release Methylphenidate in an Early Adolescent with ADHD

“…4,5 There is only one other case of tardive dystonia that we are aware with MPH. 3 In that case, Pagliaro and et al reported emergence of an episode of tardive dystonia in 9 years old male patient with ADHD who had been treated with ER MPH 27 mg/day and guanfacine 1 mg/day, who was treated with benztropine 1.5 mg IM and diphenhydramine 25 mg PO. 3 Their Naranjo score was 4 ("possible").…”

“…Rare dystonic reactions with MPH were previously reported. [3][4][5] Most of those involved acute cases which emerged after treatment initiation/ increase in dose or with MPH discontinuation while continuing to use antipsychotics. 4,5 There is only one other case of tardive dystonia that we are aware with MPH.…”

“…in addition to stimulants. [3][4][5] Here, tardive dystonic reaction in an early adolescent patient with ADHD probably related with MPH and its management was reported.…”

“…2 Tardive dystonia may emerge after long-term use of antipsychotics, anti-emetics, anti-convulsants and antidepressants. [2][3][4] Recently, cases of dystonia among children receiving MPH treatment have been reported. [3][4][5] Dystonia in those cases may be either acute or chronic and the majority of the patients were also using other agents (e.g., antipsychotics alfa-2 adrenergic blockers etc.)…”

“…[2][3][4] Recently, cases of dystonia among children receiving MPH treatment have been reported. [3][4][5] Dystonia in those cases may be either acute or chronic and the majority of the patients were also using other agents (e.g., antipsychotics alfa-2 adrenergic blockers etc.) in addition to stimulants.…”