Objective: To report the first case of oculogyric crisis (OC) secondary to flunarizine.

Background: Oculogyric crisis (OC) are an infrequent neurologic complication of dopamine antagonists treatment. They commonly present as an acute disorder, but they can also occur after weeks of starting treatment or following dose increment. They are usually a cause of disturbance and because of their variable clinical severity and infrequency may be misinterpreted. Flunarizine, a selective calcium channel antagonist, is frequently used in the treatment of episodic migraine. It is associated with aggravation or even induction of movement disorders, usually parkinsonism and very infrequently acute dystonia, but there is not in our knowledge, previous reports of (OC) due to flunarizine.

Methods: Case report.

Results: A-18- year-old female patient with a history of anorexia and episodic migraine with visual aura and frequent episodes was treated with 10 mg of FL during two weeks at

another institution. Because of lack of response, the dose was increased to 15 mg of flunarizine with the development of multiple episodes of sustained conjugated upward dystonic deviation of eyes of seconds of duration without impairment of consciousness. Brain MRI, blood and urine copper levels were normal. After the withdrawal of flunarizine, the symptoms completely remitted in less than 24 hours.

Conclusions: In our case, the presentation of the symptoms after the increase of the dose of flunarizine, the improvement following the suspension of the drug and the normal

results of the complementary studies suggest that the cause of the OC was related to the use of flunarizine. It was probably caused by a dopamine receptor blocking effect. Although there are reports of OCs produced by drugs with the same mechanism of action, this is the first case secondary to flunarizine.

Due the potencial side effects, treatment with flunarizine should be carefully indicated and doses higher than 10 mg must be avoided.

References: Federico E. Micheli, Manuel M. Fernandez Pardal, Rolando Giannaula, Mabel Gatto, Ignacio Casas Parera, Guillermo Paradiso, Marta Torres, Ralph Pikielny, and Julio Fernandez Pardal. Movement Disorders and Depression Due to Flunarizine and Cinnarizine. Movement Disorders Vol. 4, No. 2, 1989, pp. 139-346.1989 Movement Disorder Society.

J.E. Belfortea, C. MagarinÄos-Azconec, I. Armandob, W. BunÄoc, J.H. Pazoa, Pharmacological involvement of the calcium channel blocker  unarizine in dopamine transmission at the striatum. Parkinsonism and Related Disorders 8 (2001) 33-40.

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