Ziprasidone-related oculogyric crisis in an adult

Drug-induced dyskinesias are common side-effects of first-generation antipsychotics (FGAs) but are not usually related to second-generation antipsychotics (SGAs). Oculogyric crisis (OGC) is a disabling acute dystonia that affects extra-ocular muscles usually resulting in an upward deviation of the eyes, which lasts from minutes to hours.

We describe an adult patient, previously exposed to an FGA, who developed OGC on 80mg/day of ziprasidone. The movement disorder significantly improved after use of 1mg/day of clonazepam without the need to switch to another SGA.

The clinical features of the movement disorder of our patient meet the criteria for OGC. It is, sometimes, difficult to directly correlate a drug-induced dyskinesia to a SGA due to previous exposures to FGAs. The onset of OGC after exposure to ziprasidone without simultaneous use of other antipsychotic suggests a casual relationship between the former and the movement disorder. It is possible that previous use of an FGA was a risk factor for the development of OGC.

To the best of our knowledge, this is the first report of ziprasidone-related OGC in an adult patient. Physicians must be aware of its occurrence in order to improve care of patients treated with these agents.