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Acute Dystonia with Low-Dosage Aripiprazole in Tourette's Disorder

Lecturer in Psychiatry, Laboratory of Psychophysiology, Third Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, Greece

Melina Siamouli, MD

Third Department of Psychiatry, Aristotle University of Thessaloniki

Sotiris Kantartzis, MD

Third Department of Psychiatry, Aristotle University of Thessaloniki

Panagiotis Panagiotidis, MD

Third Department of Psychiatry, Aristotle University of Thessaloniki

Apostolos Iacovides, MD PhD

Assistant Professor of Psychiatry, Third Department of Psychiatry, Aristotle University of Thessaloniki

George St Kaprinis, MD PhD

Professor of Psychiatry, Director, Third Department of Psychiatry, Aristotle University of Thessaloniki

Reprints: Dr. Fountoulakis, 53 Chrysostomou Smyrnis St., 55132 Aretsou Thessaloniki, Greece, fax 30 2310-266570, kfount{at}med.auth.gr

OBJECTIVE: To report a case of an acute dystonic episode in a patient with Tourette's disorder (TD) treated with the partial dopamine agonist aripiprazole.

CASE SUMMARY: An 18-year-old male with TD was prescribed aripiprazole 10 mg orally daily, which produced a significant improvement in his symptoms. However, after 3 days of treatment, he experienced an acute episode of dystonia with facial muscle spasm, oculogyric crisis, and torticolis. All symptoms resolved after a single intramuscular injection of biperidine 5 mg. The Naranjo probability scale indicated that the adverse events were probably caused by aripiprazole.

DISCUSSION: To our knowledge, as of this writing, this is the first report concerning an aripiprazole-induced dystonic episode in an adult, and it is especially notable because it occurred at low dosage. Aripiprazole is a dopamine partial agonist and a serotonin_2A antagonist with a favorable adverse effect profile. Short-term clinical trials reported a very low incidence of extrapyramidal symptoms, with akathisia being the most common, although there have been reports of severe extrapyramidal symptoms in a 3-year-old child and in an adolescent with a previous history of such symptoms.

CONCLUSIONS: Acute dystonic phenomena may be caused by aripiprazole, although the drug's suggested mode of action largely precludes them.

Key Words: acute dystonia, aripiprazole, extrapyramidal symptoms, Tourette's disorder

Published Online, March 28, 2006. www.theannals.com, DOI 10.1345/aph.1G331