Objective: To report a case of clonazepam induced withdrawal emergent dyskinesia.

Background: Withdrawal emergent syndrome was first described in 1973 when it was noticed that children abruptly withdrawn from chronic treatment with antipsychotic medication developed choreiform movements resembling Sydenham chorea. The condition, although often alarming, is self-limited and typically remits with discontinuation of the offending agent, usually within a few days. GABA is an important neurotransmitter in motor function, therefore an imbalance between GABA and dopamine could account for the incidences of TD in individuals who take anxiolytics. The benzodiazepine clonazepam is associated with TD when patients stop taking the medication acutely. Fast withdrawal from benzodiazepines can lead to withdrawal-emergent dyskinesia, a reversible form of TD, likely caused by the dopamine hypersensitivity.

Method: Case Report

Results: 62 year old Mister X presents with a history of involuntary movement of tongue since1 month, subacute onset with frequent episodes of repetitive, stereotypical, to and fro movements of tongue associated with drooling of saliva, difficulty in swallowing and speech with occasional tongue bite. Drug history- clonazepam 0.5 mg since 2 years. On examination- no kf ring, mmse 30/30, speech was dysarthric with tongue and oral dyskinesia. rest of the examination was normal. Investigation showed normal routine blood work up and serology. Peripheral smear for acanthocytes was normal. EEG, Echo was normal. MRI Brain was normal. Final Diagnosis -Withdrawal Emergent Syndrome due to Clonazepam.

Conclusion: Withdrawal Emergent Syndrome is a under reported entity in world literature. Anxiolytics including benzodiazepines are known to cause TD, Clonazepam which is a commonly used and abused drug can cause withdrawal emergent syndrome as illustrated in our case report, which is first of its kind in literature. Diazepam induced withdrawal symptoms has been reported in ten cases previously in 1982 but none on clonazepam. This insight will be helpfull to movement disorder and general clinicians to treat this uncommon drug induced movement disorder.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clonazepam-as-a-cure-or-a-cause-withdrawal-emergent-syndrome/