Objective: We aimed to characterize the spectrum of DIMDs, and the culprit agents commonly encountered in the movement disorder clinic. We also set out to study the response to therapy, and the impact on the quality of life.

Background: Drug-induced movement disorders (DIMDs) form an important treatable subgroup of movement disorder, which despite conferring a significant iatrogenic burden tend to be under-recognized and inappropriately managed. DIMDs are cause by dopamine D2 receptor blocking agents which include not only the first- and second-generation antipsychotics, but also certain antiemetic and prokinetic agents.

Method: It is a prospective cohort study, conducted from 2020-22 including 55 consecutive DIMDs patients presenting to our movement disorder clinic.  Patients were assessed using UPDRS, UDRS, BARS, and AIMS clinical rating scale at presentation and at six months. The quality of life was assessed using EuroQol(EQ-5D-5L).

Results: Out of 55 patients, 14(25.45%) had Acute/subacute DIMD and 41(74.55%) had chronic DIMD. Chronic DIMD occurred more commonly in the elderly age group (50.73±16.92) years compared to the acute/subacute group (35.28±19.04) (p=0.006). The most common movement disorders in acute-subacute DIMD was dystonia (42.86%) followed by parkinsonism(35.71%) whereas parkinsonism(39.02%) was frequent in chronic DIMD followed by tardive dyskinesia(29.27%). The class of drugs most commonly implicated were antipsychotics(38.46%) followed by prokinetic agents(33.85%). DIMDs in 13(23.64%) patients were caused by two or more offending agents. The mean duration of exposure was 5.33 days in acute/subacute DIMDs and 275.34 days(~39 wks2 days) in patients with tardive DIMD. Patients with acute/subacute DIMDs showed significant improvement in severity scales(p<0.05). Patients with tardive DIMD showed significant improvement in UPDRS and AIMS scales(p<0.05). Quality of life scales showed significant improvement in perceived health though patients with tardive DIMDs failed to return to the premorbid state.

Conclusion: In addition to anti-psychotic agents we observed a significant number of prokinetic agents causing DIMDs as compared to previous studies. We also observed that more than one movement disorder can co-exist and more than one offending agent may be responsible for the causation, thereby making it challenging for the clinician to identify the culprit agent in the early stages, when it may be reversible.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-study-of-clinical-spectrum-risk-factors-and-outcome-of-drug-induced-movement-disorders/