Treatments for movement disorders

What are movement disorders?

Movement disorders and extrapyramidal symptoms are common side effects of many antipsychotic medications. Extrapyramidal symptoms include tardive dyskinesia, a severe and chronic condition involving repetitive, involuntary movements, most commonly occurring around the mouth and face. Akathisia is another extrapyramidal symptom, and is characterised by a feeling of restlessness and movements such as shuffling of the legs, pacing, rocking from foot to foot, or the inability to sit down or stand still. These movements are typically bilateral and relatively symmetrical. Medications prescribed to treat the side effects of antipsychotic drugs increases adherence to antipsychotics, which reduces the risk of psychotic relapse.

What is the evidence for adjunctive therapies for movement disorders?

Moderate quality evidence suggests a large effect of 5-HT2A antagonists for improving akathisia symptoms when compared to placebo, with no differences between groups in study attrition or sedation. Moderate to low quality evidence suggests improved tardive dyskinesia with Pyridoxal 5 phosphate (Vitamin B6).

Moderate quality evidence suggests no benefit of GABA-acting medications, ceruletide or Vitamin E for tardive dyskinesia, although there may be greater deterioration of symptoms with placebo. Moderate to low quality evidence also suggests no benefit of cholinergic medications, and low quality evidence is uncertain of the benefit of other compounds such as noradrenergic or dopaminergic medications, benzodiazepines, evening primrose oil, insulin, lithium, oestrogen, or phenylalanine.

March 2019

Last updated at: 12:26 am, 21st March 2019
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