Elnoor Muhanad, Bokhari Syed Ali, Singh Meghana, Mohamed Idriss A
Psychiatry, Al Amal Psychiatric Hospital, Emirates Health Services, Dubai, ARE.
Cureus. 2024 Aug 30;16(8):e68231. doi: 10.7759/cureus.68231. eCollection 2024 Aug.
Antipsychotic medications, while crucial in managing severe psychiatric disorders such as schizophrenia and bipolar disorder, are frequently associated with extrapyramidal symptoms (EPS) and tardive dyskinesia (TD). TD, characterized by repetitive, involuntary movements, especially of the face and limbs, poses a substantial clinical challenge due to its often irreversible nature. Conventional management strategies, including dose reduction and switching to atypical antipsychotics, frequently offer limited success, prompting exploration of alternative therapies. This case report highlights the effectiveness of vitamin E, a potent antioxidant, in treating a 28-year-old male with severe antipsychotic-induced EPS and TD, unresponsive to traditional therapies. The patient, who had been receiving paliperidone injections as part of his psychotic disorder treatment regimen, developed marked EPS, including muscle rigidity, a parkinsonian gait, significant motor disturbances as well as tardive dyskinesia. Despite discontinuation of paliperidone and initiation of procyclidine, propranolol, clonazepam, and omega-3 supplements, his symptoms persisted. Introduction of oral vitamin E at 400 IU daily led to a dramatic improvement, with an 80% reduction in EPS and TD symptoms within weeks. The patient's Abnormal Involuntary Movement Scale (AIMS) score decreased from 24 to 4, and his overall quality of life improved significantly. Gradual increase of vitamin E dosage to 1200 IU daily, coupled with tapering of other medications, eventually led to complete resolution of symptoms, as evidenced by an AIMS score of 0. The patient maintained symptom-free status during follow-up, with no recurrence of psychotic symptoms. This case underscores the potential role of vitamin E as a viable adjunctive treatment for TD, particularly in patients who do not respond adequately to conventional therapies. While the literature presents mixed evidence regarding vitamin E's effectiveness, this case adds to the growing body of research suggesting its benefits, especially when introduced early in the disease course. Further large-scale studies are warranted to establish the most effective treatment protocols and identify patient populations most likely to benefit from vitamin E therapy.
抗精神病药物在治疗精神分裂症和双相情感障碍等严重精神疾病方面至关重要，但常与锥体外系症状（EPS）和迟发性运动障碍（TD）相关。TD的特征是重复性、不自主运动，尤其是面部和四肢的运动，由于其通常具有不可逆性，构成了重大的临床挑战。传统的管理策略，包括减少剂量和换用非典型抗精神病药物，往往成效有限，促使人们探索替代疗法。本病例报告强调了维生素E（一种强效抗氧化剂）在治疗一名28岁男性严重抗精神病药物所致EPS和TD方面的有效性，该患者对传统疗法无反应。该患者在其精神病治疗方案中接受帕利哌酮注射，出现了明显的EPS，包括肌肉僵硬、帕金森步态、明显的运动障碍以及迟发性运动障碍。尽管停用了帕利哌酮并开始使用丙环定、普萘洛尔、氯硝西泮和ω-3补充剂，但其症状仍持续存在。每天口服400国际单位的维生素E后症状显著改善，数周内EPS和TD症状减少了80%。患者的异常不自主运动量表（AIMS）评分从24降至4，其整体生活质量显著提高。维生素E剂量逐渐增加至每天1200国际单位，同时逐渐减少其他药物用量，最终症状完全缓解，AIMS评分为0即为证明。患者在随访期间保持无症状状态，未再出现精神病症状。本病例强调了维生素E作为TD可行辅助治疗方法的潜在作用，特别是对于那些对传统疗法反应不佳的患者。虽然文献中关于维生素E有效性的证据不一，但本病例增加了越来越多表明其益处的研究，尤其是在疾病病程早期引入时。有必要进行进一步的大规模研究，以确定最有效的治疗方案，并确定最可能从维生素E治疗中获益的患者群体。
