Department of Psychiatry, JIPMER, Pondicherry, India.
Indian J Pharmacol. 2012 May;44(3):421-2. doi: 10.4103/0253-7613.96355.
Identification and management of drug-induced movement disorders is a clinical challenge, more so when the clinical presentation is atypical. A young male with acute mania was under treatment with sodium valproate and risperidone. He developed tremors of right hand and neck. These were present at rest and exacerbated by mental activity, when under observation and during voluntarily initiated activity. There were no associated extra pyramidal symptoms or cerebellar signs. Investigations for other common causes of tremors did not reveal any evidence except for low value of serum vitamin B12 levels. The tremors persisted after the withdrawal of valproate, but resolved following the withdrawal of risperidone. It is a common dictum that drug-induced tremors are bilateral. This may not be true always as we found out in our case. These movements were probably induced by risperidone. This atypical presentation could be due to concurrent use of valproate and low serum vitamin B12 levels.
药物引起的运动障碍的识别和处理是临床挑战，尤其是当临床表现不典型时。一名年轻男性患有急性躁狂症，正在接受丙戊酸钠和利培酮治疗。他出现了右手和颈部震颤。这些震颤在休息时出现，并在观察和自愿活动时加重。没有其他锥体外系症状或小脑体征。除了血清维生素 B12 水平较低外，其他常见震颤原因的检查均未发现任何证据。丙戊酸钠停药后震颤仍持续存在，但利培酮停药后震颤缓解。药物引起的震颤通常是双侧的，这是一条常见的规律。但正如我们在本例中发现的那样，情况并非总是如此。这些运动可能是由利培酮引起的。这种不典型的表现可能是由于丙戊酸钠的同时使用和血清维生素 B12 水平低所致。
