Objective: To describe two cases of oculogyric crisis caused by risperidone

Background: The oculogyric crisis (OGC) is an acute dystonic movement disorder of the eye, characterized by upward, conjugate, and paroxysmal deviation of the eyes with a duration of several seconds to hours. The insidens is rare, but commonly seen with the administration of first-generation antipsychotics. Second-generation antipsychotics, such as risperidone, are not often linked with OGC

Method: The present study is a case series of two schizophrenic patients admitted for oculogyric crisis after being treated with risperidone

Results: Case 1, a 23-year-old woman, fully alert, was admitted to the ER with tonic upwards deviation on both eyes, accompanied by dystonic posturing on the neck, lasting more than 1 hour. The patient was diagnosed with schizoaffective disorder 10 years ago. For 8 years, the patient had been taking risperidone at a dose of 2 mg bid. The OGC symptoms were recurrent once every two months, with a 5-minute duration. These symptoms were worsened whenever the dose was increased due to the worsening of the schizophrenic symptoms. After increasing the dose became 3 mg bid, the frequency of OGC became more frequent, namely 3 times a month. Moreover, in the last 1 day, the duration of OGC was longer, becoming more than 1 hour.

Case 2, a 54-year-old woman, diagnosed with hebephrenic schizophrenia 15 years ago, was admitted to the hospital with recurrent tonic upwards deviation on both eyes, dystonic posturing on the neck, and stiffness in her left hand since 1,5 months ago, right after she was prescribed risperidone 3 mg bid. The symptoms were recurrent, with approximately 1 one-hour duration.  

In both cases, the OGC disappeared after the risperidone was tapered off. After two months of follow-up, OGC never occurred again

Conclusion: OGC can appear, both immediately or delayed, after consuming risperidone and the severity was dose-dependent. The longer duration of the risperidone treatment is a possible cause of OGC symptoms to worsen. Discontinuation of drugs suspected of causing OGC is the main principle in the management of drug-induced movement disorder.

References: 1. Barow E, Schneider SA, Bhatia KP. Oculogyric crises: etiology, pathophysiology and therapeutic approaches. Parkinsonism Relat Disord. 2017;36:3–9.
2. Mahal P, Suthar N, et al. Spotlight on oculogyric crisis: a review. Indian J Psychol Med. 2021;43(1):5–9
3. Möller HJ. Risperidone: a review. Expert Opin Pharmacother. 2005;6:803–18

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-rare-manifestation-of-oculogyric-crisis-in-schizophrenia-patients-with-risperidone-case-series/