Extrapyramidal reaction leads patients to despair – 06/04/2023 – Health

“It seems that you have no place in the world: if you’re sitting down, you want to get up. If you’re standing up, you want to run away. You start to feel all your clothes touching your skin (and that bothers A LOT). It’s like not fitting in. in one’s own skin. Too tense.”

That was the story that the journalist Carla bigatto, from BandNews, did on Twitter after taking Plasil (metoclopramide) into a vein in a hospital in February to end a feeling of nausea. The 41-year-old said she had only just discovered that she was having an extrapyramidal reaction, even though she had felt the same “death urge” several times since childhood.

Like Carla, those who suffer from an extrapyramidal reaction often do not know the condition, nor how they got into that state. These symptoms, similar to those of an anxiety attack, are just part of the side effects that can affect patients who use some types of medication, mainly antipsychotics and antiemetics (against nausea, such as Plasil and Bromopride).

According to neurologist Thaís Rodrigues, from Hospital AC Camargo, an extrapyramidal reaction is what a person feels when a medication changes areas of the brain that control fine movements, muscle tone control.

“Our entire motor pathway, which includes voluntary movement, is called the pyramidal system. There are several fibers, several areas of the cerebral cortex that process our voluntary movement. movement, tonus control. These other pathways are called the extrapyramidal system. When we have some dysfunction of the extrapyramidal pathway, we have movement dysregulation”, says Rodrigues.

The neurologist says that this deregulation can cause hypokinesia, which causes less movement, greater difficulty in mobility and greater slowness, or hyperkinesia, which leads to more movement, with uncontrolled tone and tremors.

The symptom reported by Carla Bigatto was akathisia, a motor condition characterized by the difficulty of staying still, with restless thinking and a feeling of anxiety.

“It’s sad to know only now, at the age of 41, that on at least two occasions in my childhood (and many others in adult life) that desire to die while being hospitalized was nothing more than an avoidable brain reaction. Sad to know that I suffered for nothing ( and so many people suffer every day!)”, wrote the journalist.

Hundreds of people commented on Carla’s post on social media, describing their own dramas. Most described symptoms similar to those reported by the journalist, such as restlessness and anxiety, as well as despair.

According to the Plasil leaflet, for example, the extrapyramidal reaction affects 1% to 10% of patients using the drug. Despite this high percentage, Plasil is still frequently used in emergency rooms for motion sickness.

“Since there are other antiemetics available such as Dramamine and Ondansetron [Vonau], whenever possible we tend to opt for these medications. As much as it is not a very common reaction, it exists and is uncomfortable, but Plasil is still widely used today. This did not become a reason to contraindicate the medication”, said the AC Camargo neurologist.

In the United States and in some European countries, regulatory bodies are already debating ways to at least restrict use.

Affected patients may still have other reactions, often confused with signs of panic attacks, Tourette’s syndrome and anxiety, in addition to Parkinson’s and stroke.

“Among these extrapyramidal reactions, there are some more classic manifestations. One of them is what we call drug parkinsonism, which leads to many symptoms of Parkinson’s disease: muscle stiffness, increased tone, tremor and exacerbated slowness of movement. This can be induced by medication, including antiemetics such as Plasil and Domperidone, and some antipsychotics used in psychiatric treatments.”

Another possible manifestation, according to the doctor, is dyskinesia, an erratic, involuntary movement that can lead to an atypical movement of the mouth and tongue, but which can also happen in other parts of the body.

She explains that usually the extrapyramidal reaction occurs more acutely soon after the application of the medication, but it can also happen later, especially in those who make prolonged use of these medications.

“It can even happen with oral medication purchased at pharmacies. Anyone who has a reaction like this should avoid taking the medication at other times, either orally or intravenously. You have to look for another medication because the chance of [a reação] recourse exists and is greater”, he warns.

Rodrigues states that extrapyramidal reactions are more common in children and young adults. The package leaflet for Plasil even contains a contraindication for use by children under one year old and a recommendation for use with caution in children and young adults, referred to as “special populations”.

Regarding the treatment of those who suffer the extrapyramidal reaction, the neurologist says that there is no immediate antidote. The solution, then, is to control the patient’s symptoms.

“We need to keep these cases under observation, do laboratory tests many times to see if that had a more serious implication in the body. But, most of the time, removing the agent that caused the reaction tends to resolve itself. This can be resolved. take a few days and even weeks, but the trend is that it evolves with the improvement, yes.”

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• Difficulty staying calm
• Feeling restless, moving your feet and hands a lot, for example
• Movement disorders such as tremors, involuntary movements (dyskinesia), muscle spasms (dystonia) or restless movements such as moving your legs frequently or being unable to sit still (akathisia)
• Slow movements or shuffling gait
• Changing sleep patterns
• Difficulty concentrating
• voice change
• Difficulty swallowing
• Involuntary movements of the face

Drugs that can cause an extrapyramidal reaction

High risk:

• antipsychotics – haloperidol (Haldol), pimozide, trifluperazine, chlorpromazine, fluphenazine, aripripazole, sulpiride, risperidone
• Antiemetics (against nausea) – metoclopramide (Plazil), bromopride (Digesan), droperidol, clebopride, prochlorperazine, levosulpiride
• Antihistamines (antiallergic) – promethazine
• Antivertigo (against dizziness) – cinnarizine, flunarizine
• Antihypertensive (to lower blood pressure) – reserpine, alpha methyldopa
• Anthelmintics (against worms) – piperazine
• Others – valproic acid, lithium, tetrabenazine

Low risk:

• Antipsychotics or neuroleptics – quietiapine, clozapine, olanzapine
• Antiemetics (against nausea) – domperidone, itopride, ondansetron
• antidepressants – fluoxetine, sertraline, paroxetine, escitalopram, citalopram and others that act on serotonin reuptake