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Related Experiment Videos

Polypharmacy and EPS in a child; a case report.

Aysegul Yolga Tahiroglu1, Ayse Avci

  • 1Department of Child and Adolescent Psychiatry, Cukurova University Medical Faculty, Turkey. ayolga@cu.edu.tr

Psychopharmacology Bulletin
|May 22, 2007
PubMed
Summary
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Extrapyramidal symptoms (EPSs), like oculogyric crisis, are rare side effects of valproic acid, especially in children. This case highlights EPS development in a child on multiple medications, emphasizing careful monitoring for adverse drug reactions.

Area of Science:

  • Neuroscience
  • Pharmacology
  • Pediatrics

Background:

  • Extrapyramidal symptoms (EPSs) are associated with D2 receptor blockade.
  • Selective serotonin-reuptake inhibitors (SSRIs) can induce EPSs; tricyclic antidepressants rarely do.
  • Valproic acid is very rarely associated with EPS, particularly in pediatric patients.

Observation:

  • A 10-year-old girl on methylphenidate and valproic acid developed EPSs.
  • Imipramine was added to her treatment regimen.
  • Within three days, she experienced an oculogyric crisis with sustained upward gaze and ocular pain.

Findings:

  • The combination of methylphenidate, valproic acid, and imipramine precipitated an oculogyric crisis.
  • The patient's symptoms were rapidly resolved with benztropine administration.

Related Experiment Videos

  • This case underscores the potential for rare adverse drug reactions in pediatric polypharmacy.

    • Implications:

    • Clinicians should consider the risk of EPS when prescribing multiple psychotropic medications to children.
    • Careful monitoring for oculogyric crisis and other EPS is crucial in pediatric patients.
    • Prompt recognition and treatment of EPS with anticholinergic agents like benztropine are effective.