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Degenerative Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James A. Mastrianni, Elizabeth A. Harris
At onset, the clinical signs consist of cerebellar ataxia, pyramidal signs, which sometimes even precede ataxia, and in most patients, ophthalmoplegia. As the disease progresses, other symptoms occur in variable degrees, such as dysphagia, dysphonia, tongue atrophy, deep sensory loss, peripheral sensory–motor axonal neuropathy, pes cavus, amyotrophy, and fasciculations. Dystonia is the most common extrapyramidal symptom. Rarely, rigidity, tremor, and chorea have also been reported.
Pharmacological Management of Parkinson’s Disease
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Newman Osafo, Samuel Obeng, David D. Obiri, Oduro K. Yeboah, Leslie B. Essel
Although they are used as adjuncts in the management of PD, anticholinergic drugs, notwithstanding, are relevant to PD management since they offer different action path that attenuate some of the worrying symptoms of the disease, predominantly, reflex resting tremor. Anticholinergics are employed as monotherapy during early stages but as adjunctive therapy administered with l-dopa at advanced stages of the disease (Olanow and Koller, 1998; Sweeney, 1995). They are as such potentially advantageous in delaying the need for LD treatment when used early in the disease progression. Anticholinergics used in the management of PD makes it possible to reduce the dose of LD which would have otherwise been given in advanced stage of the disease hence prolonging the use of LD (Bassi et al., 1986). In practice, these drugs are also relevant as they help attenuate extrapyramidal symptoms seen with treatment with antipsychotics (Brocks, 1999).
Life Care Planning for Depressive Disorders, Obsessive-Compulsive Disorder, and Schizophrenia
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
First generation or conventional antipsychotics include perphenazine, haloperidol, loxapine, and pimozide. Second generation or atypical antipsychotics include clozapine, olanzapine, risperidone, ziprasidone, quetiapine, aripiprazole, and lurasidone. Conventional antipsychotics are associated with troublesome and serious side effects such as tardive dyskinesia (abnormal, involuntary movements commonly of the mouth, face, or extremities) and extrapyramidal symptoms (restlessness, tremors, muscle contractions, and rigidity). Common side effects associated with the use of atypicals include drowsiness/sedation, dry mouth, constipation, dizziness, orthostatic hypotension, nausea, extrapyramidal symptoms (but reduced in comparison with conventional antipsychotics), weight gain, and metabolic effects. Since their introduction, atypical antipsychotics have been recommended over conventional antipsychotics due to their decreased risk of tardive dyskinesia and extrapyramidal symptoms. However, there has been some debate about this recommendation due to some evidence of comparable efficacy with conventional antipsychotics and the serious metabolic side effects that can occur with atypical antipsychotics (APA, 2009). The good news is that research continues into the development of effective antipsychotic treatment with tolerable side effects.
The incidence and economic burden of extrapyramidal symptoms in patients with schizophrenia treated with second generation antipsychotics in a Medicaid population
Published in Journal of Medical Economics, 2022
Aditi Kadakia, Brenna L. Brady, Carole Dembek, G. Rhys Williams, Justine M. Kent
While second generation antipsychotics (SGAs) have a lower EPS burden in general compared to the first generation or “typical” antipsychotics, they have not met initial expectations of being completely EPS-free medications9–11. In fact, varying degrees of EPS have been reported in up to 37% of all patients taking SGAs12–14. According to the latest version of the American Psychiatric Association treatment guidelines for schizophrenia, the risk of EPS among the SGAs is lowest for clozapine, iloperidone, and quetiapine, followed by aripiprazole, brexpiprazole, cariprazine, and ziprasidone, then olanzapine and asenapine, and finally lurasidone, paliperidone, and risperidone6. Extrapyramidal symptoms can negatively impact quality-of-life for patients and are associated with increased morbidity and mortality13,15. Significant unmet needs remain to develop medications that provide efficacy in treating the spectrum of symptoms of schizophrenia while reducing side-effect burden, including that of EPS.
Dyskinesia is most centrally situated in an estimated network of extrapyramidal syndrome in Asian patients with schizophrenia: findings from research on Asian psychotropic prescription patterns for antipsychotics
Published in Nordic Journal of Psychiatry, 2021
Seon-Cheol Park, Gyung-Mee Kim, Takahiro A. Kato, Mian-Yoon Chong, Shih-Ku Lin, Shu-Yu Yang, Ajit Avasthi, Sandeep Grover, Roy Abraham Kallivayalil, Yu-Tao Xiang, Kok Yoon Chee, Andi Jayalangkara Tanra, Chay Hoon Tan, Kang Sim, Norman Sartorius, Naotaka Shinfuku, Yong Chon Park, Toshiya Inada
Our findings demonstrate that earlier antipsychotic-induced extrapyramidal symptoms can be divided into three groups – extrapyramidal syndrome without parkinsonism, postural instability and gait difficulty-dominant parkinsonism, and tremor-dominant parkinsonism. This grouping may be consistent with the conceptualization by Inada and Yagi [46], which divided extrapyramidal side effects into dystonia, akathisia, parkinsonism and rabbit syndrome, and tardive dyskinesia based on their acute and chronic aspects (Figure 3). Since acute dystonia, akathisia, and parkinsonism have been proposed as risk factors for tardive dyskinesia [41], the conceptualization of extrapyramidal syndrome without parkinsonism (SIA, AKA, TON, and KIN) can be partly supported. The division of parkinsonism into GAI-BRA and RIG-TRE-OVE subgroups is partly consistent with the PD subtypes, including tremor-dominant PD and postural instability and gait difficulty-dominant PD [47]. Thus, parkinsonism may need a different approach as it may have different underlying mechanisms and markers depending on the case. Moreover, the GAI-BRA, TRE-OVE, RIG-TON, RIG-OVE, AKA-TON, AKA-KIN, and AKA-OVE inter-connections are partly consistent with the three distinctive clusters of parkinsonism.
Evaluating lurasidone as a treatment option for bipolar disorder
Published in Expert Opinion on Pharmacotherapy, 2020
Ziad Ali, Cunyet Tegin, Rif S. El-Mallakh
The negative maintenance treatment of bipolar I disorder of lurasidone was published and provides additional safety information [30]. The study consisted of 20 weeks of open-label lurasidone (20–80 mg/d) combined with lithium or valproate as an initial stabilization phase followed by 28 weeks of double-blind randomized assignment to lurasidone (20–80 mg/d) (N = 246) or placebo (N = 250), in combination with lithium or valproate [30]. The proportion of patients who experienced at least one adverse event in both the open-label and double-blind phases were 66 and 62.2%, respectively. During the open-label phase and the double-blind phase, discontinuation rate due to an adverse event was 6.1 and 3.3%, respectively. Severe adverse events were experienced by 7.3% of patients in the open label phase and 5.3% of patients receiving lurasidone in the double-blind phase. Eleven patients (4.5%) in the lurasidone group vs. 16 patients (6.4%) in placebo group reported treatment emergent suicidal ideation. Extrapyramidal symptoms were reported by 2.6% of patients in the open-label phase. In the open-label phase, ≥ 7% increase in weight was reported in 9.9% of patients, but 3.7% experienced a ≥ 7% decrease in weight. In the double-blind phase, mean weight gain was +0.2 kg in the lurasidone group compared to none in the placebo group [30].