Extrapyramidal symptoms are a reaction of the body that arises when an area of the brain responsible for coordination of movements, called the Extrapyramidal System, is affected. This can occur either by side effects of drugs such as Metoclopramide, Quetiapine or Risperidone, for example, or certain neurological diseases, which include Parkinson's disease, Huntington's disease or stroke sequelae.
Involuntary movements such as tremors, muscle contractures, difficulty walking, slowing movements or restlessness are some of the main extrapyramidal symptoms, and when associated with medications, they may occur soon after use or may appear slowly, for their continuous use for years or months.
When it appears due to the sign of a neurological disease, extrapyramidal movements usually worsen gradually over the years as the disease worsens. Also check out the conditions and diseases that cause tremor in the body.
How to identify
The most frequent extrapyramidal symptoms include:
- Difficulty staying calm;
- Feeling restless, moving your feet a lot, for example;
- Changes in movement, such as tremors, involuntary movements (dyskinesia), muscle spasms (dystonia) or restless movements, such as moving your legs frequently or not being able to stand still (akathisia);
- Slow or slow movements;
- Changing sleep patterns;
- Difficulty concentrating;
- Voice alterations;
- Difficulty swallowing;
- Involuntary movements of the face.
Often these symptoms can be confused as being signs of other psychiatric problems like anxiety, panic attack, Tourette 's syndrome or even with symptoms of stroke.
What are the causes
Extrapyramidal symptoms can appear as a side effect of medications, right after the first dose or arise as a result of continued use, taking between a few weeks to months to start, and therefore, when they appear, it is advisable to consult the doctor who prescribed the medication to evaluate the need to reduce the dose or make adjustments in treatment. In addition, although they may occur in anyone, they are more common in women and elderly patients.
These symptoms can also be the consequence of a neurological disease, with Parkinson's disease being the main representative. Find out what causes Parkinson's disease, how to identify and treat it.
Other neurological diseases include degenerative diseases such as Huntington's disease, Lewy body dementia, sequelae of stroke or encephalitis, and dystonia or myoclonus, for example.
List of medicines that may cause
Some of the medications that most often cause the appearance of extrapyramidal symptoms are:
| Class of drug | Examples |
| Antipsychotics | Haloperidol (Haldol), Chlorpromazine, Risperidone, Quetiapine, Clozapine, Olanzapine, Aripiprazole; |
| Antiemetics | Metoclopramide (Plasil), Bromopride, Ondansetron; |
| Antidepressants | Fluoxetine, Sertraline, Paroxetine, Fluvoxamine, Citalopram, Escitalopram; |
| Anti-competitive | Cinarizine, Flunarizine. |
What to do when they arise
When an extrapyramidal symptom appears it is very important to consult, as soon as possible, the doctor who prescribed the medication that may be causing it to appear. It is not recommended to stop taking or changing the medicine without a medical indication.
The doctor may recommend adjustments in treatment or may change the medication used, however, each case needs to be evaluated individually. In addition, throughout the treatment with this type of medicine, frequent reassessments are necessary and it is therefore important to go to all the review visits, even when there are no side effects. Check the reasons for not taking medicines without doctor's advice.
