Objective: To report the case of a pharmaco-induced oro-facial dyskinesia and akathisia.

Background: Dyskinesia is a hyperkinetic, disorganized, involuntary movement disorder that can either be focal (oro-facial, limbs, trunk) or affect multiple areas of the body. Akathisia is defined as a compulsory need to move by standing up or to constantly shift from one foot to another. These movement disorders are often associated to neuroleptic use and may be permanent even after treatment discontinuation(1).

Method: We report the case of a 53 y.o man, who was diagnosed with Parenchymatous Neurobehçet’s disease 4 years prior, but refused treatment. Due to his affliction, the patient presented with numerous neurological symptoms including pseudobulbar syndrome with spasmodic laughter and crying and dysarthria, narcolepsy, as well as symptoms of encephalitis with behavioral disorders (heightened libido, kleptomania). Physical examination had found a right sided pyramidal syndrome with a discrete diminished strength of the right lower limb at 4/5 and severe dysarthria. He was treated for his Neurobehçet with an azathioprine and rituximab protocol and olanzapine (5mg/day) was prescribed for his behavioral disorders. Follow-up examination after three months found an oro-linguo-facial dyskinesia of the right side of the face associated with akathisia.

Results: The occurrence of oro-linguo-facial dyskinesia is linked to a disruption of the nigrostriatal pathway induced by the use of neuroleptics(2). The pharmacological characteristics of olanzapine lean towards a reduced risk of extrapyramidal manifestations compared to other neuroleptics although studies have shown that olanzapine has a high affinity for D2 receptors affinity at an elevated dosage (3). Some patients may be more exposed to these side effects due to preexisting comorbidities (1).

Conclusion: The consequences of an untreated neurologic disease are severe and may be irreversible as they lead to the appearance of added symptoms that will need to be treated separately. The use of multiple drugs that this leads to exposes the patient to an increased risk of side effects that could have been avoided. Therefore, it is important for clinicians to be vigilant towards their patient’s symptomatology to avoid a delayed diagnosis and therefore a delayed treatment.

References: 1. Sangroula D, Virk I, Mohammad W, Kahn DA. Clozapine Treatment of Olanzapine-induced Tardive Dyskinesia: A Case Report. J Psychiatr Pract. janv 2017;23(1):53‑9.
2. Suhas S, Vijayakumar HG, Venkatasubramanian G, Varambally S. Tardive Dyskinesia and Dystonia – Clinical Case Review and Grand Rounds. Journal of Psychiatry Spectrum. juin 2022;1(1):58.
3. Kapur S, Zipursky RB, Remington G, Jones C, DaSilva J, Wilson AA, et al. 5-HT2 and D2 Receptor Occupancy of Olanzapine in Schizophrenia: A PET Investigation. AJP. juill 1998;155(7):921‑8.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/oro-facial-dyskinesia-and-akathisia-following-treatment-by-olanzapine/