Extrapyramidal symptoms facts for kids

Extrapyramidal symptoms (often called EPS) are unwanted movements or feelings. They happen when certain parts of your brain that control movement are affected. These symptoms are often side effects of medicines, especially those used for mental health conditions. When caused by medicines, they are also known as extrapyramidal side effects (EPSE).

EPS can appear quickly (acute) or last a long time (chronic). They include things like stiff muscles, shaky hands, feeling restless, or having jerky movements. Sometimes, these side effects can make it hard for people to continue taking their important medicines.

What Causes Extrapyramidal Symptoms?

Extrapyramidal symptoms are most often caused by certain medicines.

Medicines That Can Cause EPS

The most common cause of EPS is a type of medicine called antipsychotics. These medicines are used to help people with certain mental health conditions. Older types of antipsychotics, like haloperidol and fluphenazine, are more likely to cause EPS. Newer antipsychotics usually have fewer side effects.

Other medicines can also cause EPS. These include some anti-nausea medicines, like metoclopramide. Even some medicines for depression, such as duloxetine or fluoxetine, have been linked to EPS in some cases.

Other Causes

Sometimes, EPS can be caused by other things, like damage to the brain or infections such as meningitis. However, when doctors talk about "extrapyramidal symptoms," they usually mean those caused by medicines.

How Doctors Find Out About EPS

It can be tricky to measure how severe extrapyramidal symptoms are. So, doctors often use special rating scales. These scales help them check how much the movement problems are affecting a person.

Some common scales include the Simpson-Angus Scale (SAS) and the Abnormal Involuntary Movement Scale (AIMS). These tools help doctors decide if a medicine is helping enough, or if the side effects are too difficult for the patient. This helps them choose the best treatment plan.

Types of Extrapyramidal Symptoms

There are different types of extrapyramidal symptoms:

• Acute dystonia: These are sudden, painful muscle spasms. They can affect the neck, jaw, back, arms, legs, eyes, throat, and tongue. Young men are at a higher risk for this.
  • An Oculogyric crisis is a type of dystonia where the eyes get stuck looking upwards for a long time.
• Akathisia: This is a feeling of inner restlessness. People with akathisia might feel tense, nervous, or anxious. They often pace around and find it hard to sit still.
• Pseudoparkinsonism: This looks a lot like Parkinson's disease. Symptoms include stiff muscles, slow movements, shaky hands, a blank facial expression, and a shuffling walk. Older people are more at risk.
• Tardive dyskinesia: These are uncontrolled, jerky muscle movements. They usually affect the lower face and hands or feet. This can be a long-lasting condition, especially after taking antipsychotics for a long time.

How Extrapyramidal Symptoms Are Treated

The treatment for EPS depends on the specific type of symptom. Doctors try to reduce the symptoms, often by adjusting the medicines that caused them.

If the EPS are caused by an antipsychotic medicine, doctors might:

• Lower the dose of the medicine.
• Switch to a different type of antipsychotic. Newer ones like aripiprazole or quetiapine often have fewer EPS side effects.

Treating Dystonia

For sudden, severe dystonia, doctors often give medicines called anticholinergics. These medicines can quickly relax the muscles. Sometimes, they are given as an injection to work even faster.

Treating Akathisia

Some newer antipsychotics can still cause akathisia. If this happens, switching to an antipsychotic with a lower risk might help. Medicines called beta blockers, like propranolol, are often used to treat akathisia. Other medicines like clonidine can also be used. Anticholinergic medicines usually don't help with akathisia.

Treating Pseudoparkinsonism

Doctors usually try to reduce or stop the medicine that caused pseudoparkinsonism first. If that's not possible, they might use anticholinergic medicines. Another medicine called amantadine is sometimes used. It's rare for doctors to use medicines that increase dopamine, as they could make mental health symptoms worse.

Treating Tardive Dyskinesia

When other treatments don't work, specific medicines can be used for tardive dyskinesia. These include tetrabenazine and deutetrabenazine.

History of the Name

The name "extrapyramidal symptoms" comes from the part of the brain they affect. These symptoms are related to problems in the extrapyramidal system. This system helps control your posture and how your muscles move. It's different from another part of the brain called the "pyramidal tracts."

See also

In Spanish: Enfermedades del sistema extrapiramidal para niños

• Neuroleptic malignant syndrome
• Rabbit syndrome