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[A case of respiratory dyskinesia due to clebopride malate]
H Kawasaki1, M Yamamoto, H Okayasu
1Department of Medicine, Showa University, Fujigaoka Hospital.
Abstract:
Clebopride malate is therapeutically used for the treatment of peptic ulcer. This drug has potent antidopaminergic activity that causes acute dystonic reaction, parkinsonism and tardive dyskinesia as adverse effects. Here, we have reported an 86-year-old man who developed abnormal involuntary movement of respiratory muscles and lower limb muscles after this drug had been given for four months. This involuntary movement appeared spontaneously at resting state and disappeared during sleep. Surface EMG demonstrated a synchronous grouping discharge in m. orbicularis oris, m. sternocleidomastoideus and m. interstales which synchronized with diaphragmatic movement on cinefluorography. Involuntary movement of the lower limbs was synchronous bilaterally and had little relationship with diaphragmatic movement. This involuntary movement was irregular not only in rhythm but also in duration. According to this irregular nature, we diagnosed this involuntary movement as respiratory dyskinesia with limb dyskinesia that belongs to tardive dyskinesia. After cessation of clebopride malate limb dyskinesia disappeared rapidly and respiratory dyskinesia markedly decreased. We emphasize that respiratory dyskinesia should be differentiated from psychogenic hyperventilation as easily misdiagnosed on initial examination.
Insights
Clebopride malate can cause tardive dyskinesia, including abnormal respiratory and limb movements. Promptly stopping the drug can significantly reduce these involuntary movements.
Area of Science:
- Neurology
- Pharmacology
Background:
- Clebopride malate, used for peptic ulcers, possesses antidopaminergic properties.
- Antidopaminergic drugs are known to cause adverse effects like dystonia, parkinsonism, and tardive dyskinesia.
Observation:
- An 86-year-old male developed abnormal involuntary movements in respiratory and lower limb muscles after four months of clebopride malate treatment.
- These movements occurred spontaneously at rest, ceased during sleep, and were characterized by irregular rhythm and duration.
- Surface EMG and cinefluorography revealed synchronous discharges in respiratory muscles linked to diaphragmatic movement, alongside bilateral limb movements.
Findings:
- The patient was diagnosed with respiratory dyskinesia and limb dyskinesia, classified under tardive dyskinesia.
- Cessation of clebopride malate led to rapid improvement in limb dyskinesia and marked reduction in respiratory dyskinesia.
Implications:
- This case highlights respiratory dyskinesia as a potential adverse effect of clebopride malate.
- It is crucial to differentiate respiratory dyskinesia from psychogenic hyperventilation to ensure accurate diagnosis and treatment.