Drug-Induced Abnormal Involuntary Movements: Prevalence and Treatment

Have you ever wondered how often abnormal involuntary movements (AIMs) develop following use of medications? Have you been unsure about which aspects of the history, physical examination, and laboratory tests are most likely to yield meaningful information about the etiology and treatment of drug-induced abnormal movements? If so, then the following case vignette and discussion should prove useful. Recent research indicates that the incidence of amiodarone-induced neurological side effects may be considerably lower than the third or more of patients reported by some authors.

No significant differences were observed in the time required to experience unsteadiness, nor in the symptom diary or the frequency of falls. Electrophysiologically, the results were also similar in both groups 7. Statistics show that MIMDs are more common in patients taking antipsychotic medications, with up to 30% of long-term users experiencing some form of movement disorder. However, these disorders can also occur with other medications, such as antidepressants, anti-nausea drugs, and certain epilepsy treatments. It is interesting to note that Raethjen et al.10 published the first work that demonstrated a definitive effect on the central component of physiological tremor by any drug (amitriptyline) in 2001. EPT is by far the most common mechanism of tremor generation by medications17,18 (Table 2).

Valproic acid

While lifestyle factors are not the primary cause of medication-induced movement disorders, certain habits may increase the likelihood of developing these conditions. For example, smoking can affect how the body metabolizes certain medications, potentially increasing the risk of side effects like movement disorders. Additionally, alcohol consumption can interact with medications, making it harder for the body to process them properly, which may lead to an increased risk of MIMDs.

Our telemedicine practice offers convenient, compassionate care to help you manage your condition from home. Schedule a consultation today to take the first step toward better health. The exact mechanism of theophylline-induced tremors is largely unknown, but is likely a result of enhancement of physiological tremor. Drug-induced tremors can occur when you move your body a certain way or are in certain positions. Medications that cause the tremors include certain antipsychotics, anticonvulsants, and antidepressants. Certain medications can both cause tremors and worsen any tremors you already have from Parkinson’s disease or another similar disorder.

Drug-Induced Movement Disorders: A Primer

Referral is recommended for patients with late-stage disease for consideration of device-assisted therapy. Intermittent apomorphine injections or a continuous infusion may be required in moderate– severe cases. In this context, the objective of this study was to conduct a systematic review of the literature to examine the association between medication use and the occurrence of parasomnias and SRMD. More Than Rehab offers high-quality, individualized treatment to anyone struggling with addiction.

Drug-induced movement disorders

The desensitisation increases the activity of serotonergic neurones and reduces with some delay serotonin release using an autoregulation mechanism. The delay between desensitisation and compensatory autoregulation of serotonin release would promote the occurrence of sleepwalking episodes (Juszczak, 2011). Antipsychotics, such as olanzapine and quetiapine, could also induce sleepwalking.

Subacute drug-induced movement disorders occur within days to weeks of drug ingestion. Parkinsonism-hyperpyrexia disorder, also known as akinetic crisis, is a rare but potentially fatal complication of Parkinson’s disease. It can also be precipitated by an infection or other metabolic disturbance. It is also important to exclude alternative causes, including an underlying infection, metabolic abnormalities, or stroke.

Several treatment options are available for those struggling with heroin addiction, including pharmacological treatment and behavioral therapy. You may have to undergo both pharmacological treatment and behavioral therapy to make a full recovery. Hyperkinetic disorders interfere with your day-to-day activities, and you may find it challenging to perform easy tasks. Treatment of AIMs is based on the underlying etiology (eg, metabolic, drug induced). However, symptomatic treatments are indicated to reduce motoric and psychological symptoms that impair social function and worsen quality of life.

TABLE 3.

Using these scans, your doctor can potentially rule out defects in your brain that may be causing tremors. If you cannot discontinue the medicine that is causing your tremor, your healthcare provider may change your medication dose or switch you to another medicine to drug induced tremors treat your health condition. Taking too much levothyroxine (Levoxyl, Synthroid), a medication used to treat hypothyroidism (underactive thyroid gland), can cause tremors, a symptom of hyperthyroidism.

• Medication-induced movement disorders can significantly impact daily life, but early diagnosis and appropriate treatment can provide symptom relief.
• Alcohol abuse may also cause bilateral flapping tremors, characterized by arrhythmic interruptions of sustained voluntary muscle contraction.
• However, further studies are needed to support the evidence for different pharmacological therapeutic approaches for orthostatic tremor.
• Consequently, they inhibit reuptake, releasing dopamine at the mesocorticolimbic dopaminergic nerve terminals.

Additionally, we reviewed previous studies, reference lists, and related articles in PubMed to identify any potentially overlooked or excluded publications based on the keyword equation. Tremors may also result in other symptoms like depression and anxiety, which may have severe consequences. Consequently, it prevents the reuptake of dopamine, increasing extracellular dopamine levels.

Given the etiology of the tremor to be central, a causal therapeutic approach with botulinum toxin seems not feasible. A study conducted by Wills et al. 12, investigated the effects of levodopa in a cohort of eight patients over an eight-week period. Initially, a single dose of 200 mg levodopa 50 mg carbidopa was administered, with the first video taken one-hour post-administration. Over the course of the study, the participants received 50 mg levodopa and 12.5 mg carbidopa three times daily, with doses gradually escalated to a maximum of 200 mg levodopa 50 mg carbidopa three times daily.

How Can Abnormal Involuntary Movements Be Treated?

This study searched for publications via PubMed and Google Scholar using the terms “orthostatic tremor” AND “therapy” and “shaky legs syndrome” AND “therapy”. The main inclusion criteria were a subject number ≥ 5, pharmacological treatment approaches and the presence of a prospective experimental design. Upon full‐text eligibility assessment, we further excluded 118 studies that did not meet the full inclusion criteria. To classify drugs involved in parasomnias or SRMD we used the ATC drug classification. The mainstay of treatment includes resuming anti-parkinsonian drugs, usually via nasogastric tube because of the dysphagia resulting from severe parkinsonism.

Review Date 6/13/2024

The patients described their perception of improvement on a scale of − 3 to + 3 at both one and three months. The reported adverse effects included dizziness, an increased frequency of falls, greater instability, weight gain, and depression. A rebound phenomenon was observed in six of the eight patients who did not continue participating in the study. This manifested itself in the period of two to six weeks after discontinuation of therapy through exacerbation of symptoms compared to the status prior to treatment.

The seizure-suppressive drug primidone, which is mentioned in textbooks as a treatment option, was not included in any of the studies that met the aforementioned criteria 1. According to the current German S2K guideline 17, the drug is no longer recommended for use in primary orthostatic tremor. The same applies to pramipexole, which is similarly not recommended in the current guideline, despite reports of positive effects in individual patients documented in case reports 17, 18. Controlled, prospective clinical studies would be necessary to substantiate these effects. No studies were identified regarding clonazepam meeting the above specified criteria, although it is recommended in the German S2k guideline for use in selected cases 17.

The main difference between drug-induced tremor and essential tremor is that the exact mechanism and cause of essential tremor are not known. Another difference between these two types of tremor is that drug-induced tremor tend to be quick and usually occur in cycles that last about 10 seconds. Based on this analysis of the existing literature, we can conclude that gabapentin is the treatment with the strongest evidence for the management of orthostatic tremor. With less supporting evidence, the use of perampanel and levodopa may be recommended as illustrated in Fig. However, it is important to bear in mind that the majority of studies published to date are based on small sample sizes, highlighting the need for larger clinical studies. The systematic review of evidence for the treatment of orthostatic tremor revealed a lack of high-quality studies, specifically prospective, randomized, double-blind, placebo-controlled trials.