title: Polypharmacy and EPS in a child; a case report.
abstract: Extrapyramidal symptoms (EPSs) (dystonic reaction, rigidity, and akathisia) occur as a result of D2 receptor blockade. Selective serotonin-reuptake inhibitors (SSRIs) have been reported to induce extrapyramidal signs and symptoms but tricyclic antidepressants have been rarely reported. Among the side effects attributed to valproic acid administration, the production of EPS is very rare, particularly in children. In this paper we present a case (10-year-old girl) under multiple pharmacologic treatment who developed EPSs (oculogyric crisis) shortly after the adjunct of imipramine to a combination of methylphenidate and valproic acid. Oculogyric crisis occurred on the third day of this combination treatment and these symptoms included ocular pain and sustained upward gaze. Benztropine 2 mg i.m. resulted in rapid relief of oculogyric crisis symptoms.
authors.affiliation: Department of Child and Adolescent Psychiatry, Cukurova University Medical Faculty, Turkey. ayolga@cu.edu.tr
authors.forename: Aysegul Yolga
authors.initials: AY
authors.lastname: Tahiroglu
authors.forename: Ayse
authors.initials: A
authors.lastname: Avci
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy*; D001590:Benztropine / Q000008:administration & dosage; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy; D002648:Child; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D007099:Imipramine / Q000008:administration & dosage / Q000009:adverse effects*; D007273:Injections, Intramuscular; D008774:Methylphenidate / Q000008:administration & dosage / Q000009:adverse effects*; D009460:Neurologic Examination / Q000187:drug effects; D015835:Ocular Motility Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000009:adverse effects*; D014635:Valproic Acid / Q000008:administration & dosage*
chemical_list: D011619:Psychotropic Drugs; D001590:Benztropine; D008774:Methylphenidate; D014635:Valproic Acid; D007099:Imipramine