Seiwakai Nishikawa Hospital, Hamada, Japan.
Int J Psychiatry Clin Pract. 2005;9(4):284-8. doi: 10.1080/13651500500327998.
Neuroleptic-induced extrapyramidal symptoms (EPS) are generally categorized as acute, withdrawal and tardive EPS. Here, we report two cases of a unique late-onset, long-lasting EPS (e.g., prolonged EPS); in those cases, EPS appeared a few months following initiation of haloperidol and lasted for a few months after significant reduction or complete withdrawal of neuroleptics. Case 1, a 41-year-old female, began to exhibit EPS such as bradykinesia, rigidity and parkinsonian gait 4 months after the haloperidol treatment. Her rigidity was ameliorated by a reduction of haloperidol; however, reduction of neuroleptics made it difficult for her to maintain a seated posture because of an imbalance of muscle tonus. Her EPS continued for 9 months even after haloperidol was switched to very low doses of thioridazine (10 mg/day). Case 2 is a 42-year-old female. She exhibited EPS including dysphagia and a difficulty in opening her mouth 3 months after the haloperidol treatment began. Her EPS lasted for 45 days, even after complete withdrawal of neuroleptics. The EPS observed in these two cases occurred even after prolactin levels became normal. "Prolonged EPS" is a unique subclass of neuroleptic-induced reversible EPS that might involve the coexistence of hypo- and hyper-dopaminergic transmission, especially in patients who show very low tolerance to neuroleptics.
神经阻滞剂诱发的锥体外系症状（EPS）通常分为急性、撤药和迟发性 EPS。在此，我们报告两例独特的迟发性、持续性 EPS（例如，持续性 EPS）病例；在这些病例中，EPS 在开始使用氟哌啶醇几个月后出现，并在神经阻滞剂显著减少或完全撤药后持续数月。病例 1 为 41 岁女性，在氟哌啶醇治疗 4 个月后开始出现运动徐缓、僵硬和帕金森步态等 EPS。她的僵硬通过减少氟哌啶醇得到改善；然而，由于肌肉张力失衡，减少神经阻滞剂使得她难以维持坐姿。即使氟哌啶醇转换为极低剂量硫利达嗪（10mg/天）后，她的 EPS 仍持续了 9 个月。病例 2 为 42 岁女性。她在开始氟哌啶醇治疗 3 个月后出现吞咽困难和张口困难等 EPS。即使完全撤药后，她的 EPS 仍持续了 45 天。这两例观察到的 EPS 即使催乳素水平正常后仍会出现。“持续性 EPS”是一种独特的神经阻滞剂诱发的可逆性 EPS 亚类，可能涉及低多巴胺能和高多巴胺能传递的共存，特别是在对神经阻滞剂非常低耐受性的患者中。
