BACKGROUND: Drug-induced Parkinsonism(DIP) is the second commonest cause of Parkinsonism, after idiopathic Parkinson's disease(IPD). DIP is frequently produced by antipsychotic drugs. But the clinical characteristics of DIP did not get attention by neurologist. So we studied the clinical profiles of DIP patients. METHODS: We studied the clinical profiles of thirthone patients who showed parkinsonism after antipsychotic drug treatment. We compared the score of motor part of the Unified Parkinson's Disease Rating Scale(UPDRS) between trihexyphenidyl(n=15) & amantadine(n=16) monotherapy group(initial & 4 week after treatment). RESULTS: The mean age of patients was 45 years. Bradykinesia was the 1st symptom in 26 patients(94%), tremor in 5 patients(6%). In 25 patients(81%), the first symptom appeared within 1 week after sntipsychotic treatment. There was a statistical significant negative correlation between the dosage of antipsychotic drug and the symptom-onset interval following treatment with antipsychotic drugs(simple correlation analysis, p>0.01). Bradykinesia and rigidity were appeared in all DIP patients, symmetric distribution was more common(94%, 87%) Tremor occurred in 27 patients (87%). In patients with tremor, postural or action tremor was dominant in 15 patients(56%) asymmetric distribution was more common(16/27, 59%). There are no statistical difference in motor score of UPDRS between trihexyphenidyl & amantadine monotherapy group(student t-test, p<0.05) CONCLUSIONS: Bradykinesia was the most common 1st symptom in DIP patients. Asymmertrical postural or action tremor was relativelly common in DIP. Amantadine showed the same efficacy in the treatment of DIP compared to anticholinergics.
Amantadine ; Antipsychotic Agents ; Cholinergic Antagonists ; Humans ; Hypokinesia ; Parkinson Disease ; Parkinsonian Disorders* ; Tremor ; Trihexyphenidyl

Meige's suydrome is a disorder of adults, and is characterized chiefly by prolonged symmetric dystonic contractions of the orofacial muscles. Eleven patients with prominent orofacial dystonia of unknown cause (Meige's syndrome) were examined at the department of neurology of Yongdong Severance Hospital, Yonsei Unversity Medical Center, and the following results has been obtained. 1. There were 3 men and 8 women. 2. Their ages ranged from 31 to 60 years (mean. 51.2), with the peak incidence in the 6th decade (7 of 11 patients). None of the patients was younger than 30. 3. Blepharospasm was the initial symptom in 11 patients. All patients developed the complete syndrome, blepharospasm and oromandifular dystonia. 4. Response to medication was inconsistent, but 6 of 8 patients trials resulted in some improvement: one with complete remission and 3 with marked imprvement. Clonazepam and trihexyphenidyl (Artane) were useful for the treatment of Meige's syndrome.
Adult ; Blepharospasm ; Clonazepam ; Dystonia ; Female ; Humans ; Incidence ; Male ; Muscles ; Neurology ; Trihexyphenidyl

Torsion dystonia (TD) is a clinical syndrome characterized by prolonged spasms of muscle contraction, which distort the body into typical dystonic posture. The pathological or biochemical basis of either the familial types or of most sporadic forms of idiopathic or primary TD is unknown. We present a 40-year old man who showed a kinesigenic axial dystonia with ipsilateral upper extremity atrophy for 14 years. The symptoms and signs were spontaneous onset, nonprogrwsive course, and induced by voluntary activity but relieved by rest and sleep and responded to trihexyphenidyl medication.
Adult ; Atrophy* ; Dystonia Musculorum Deformans ; Dystonia* ; Humans ; Muscle Contraction ; Posture ; Spasm ; Trihexyphenidyl ; Upper Extremity*

We report a 47-year old traumatic brain injury male patient who was treated for the rigidity and tremor with sinemet (carbidopa levodopa) and artane (trihexyphenidyl). He came to the emergency room ten days after the stopping of sinemet. Acute onset of increased obtunded, immobile, rigid, deep coma, and minimal response to a deep pain was presented. There was no evidence of the focal neurological signs. Over the next two days, he awoke with a normal mental status. His muscle tone become normal and he returned to home without residual medical problems or complications. We report a serotonin syndrome in a traumatic brain injury patient who was treated with sinemet and artane, which resulted in a dysregulation of serotonin activity.
Brain Injuries* ; Coma ; Emergency Service, Hospital ; Humans ; Male ; Middle Aged ; Serotonin Syndrome* ; Serotonin* ; Tremor ; Trihexyphenidyl

A case of acute intermittent porphyria associated with intermittent attacks of spinal myoclonus in the neck and both shoulders is reported. The patient, a 19-year-old male had also presented with attacks of intermittent left arm monoparesis and passed port-wine clored urine that was responsible for positive Watson-Schwartz reaction, about 5 weeks after taking medication including haloperidol, phenobarbital, trihexyphenidyl hydrochloride and clonazepam for the treatment of myoclonus and concomitantly complained abdominal pain and mental symptoms with the recurrence of left arm monoparesis. Each attacks of spinal myoclonus and monoparesis recovered completely.
Abdominal Pain ; Arm ; Clonazepam ; Haloperidol ; Humans ; Male ; Myoclonus* ; Neck ; Paresis ; Phenobarbital ; Porphyria, Acute Intermittent* ; Recurrence ; Shoulder ; Trihexyphenidyl ; Young Adult

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCAR) with high mortality and have a significant public health impact because of high mortality and morbidity. OBJECTIVE: To describe data the epidemiological features, etiology, and treatment of retrospectively reviewed data of all patients with SJS and TEN. METHODS: Retrospective study was conducted in patients with SJS and TEN treated from January 1, 2009 to December 31, 2013 in Dr. Hasan Sadikin General Hospital Bandung, Indonesia. RESULTS: A total of 57 patients were enrolled in the study. Thirty-nine cases of SJS (21 males and 18 females), 7 cases of SJS overlapping TEN (4 males and 3 females), and 11 cases of TEN (5 males and 6 females) were reported. All cases of SJS and TEN were caused by drugs, such as paracetamol (16.56%), carbamazepine (7%), amoxicillin (5.73%), ibuprofen (4.46%), rifampicin (3.18%), and trihexyphenidyl (3.18%). All cases were treated systemically with corticosteroid alone (100%). Seven from 57 patients (12,28%) died; 5 cases developed sepsis and 2 cases developed respiratory failure. The mortality rate was 7.69% in SJS, 0% in SJS/TEN overlap, and 36.36% in TEN. CONCLUSION: The role of systemic corticosteroids in SJS and TEN are still controversial, but with a prompt and earlier treatment reduces mortality and improves outcomes of SJS and TEN patients.
Acetaminophen ; Adrenal Cortex Hormones ; Amoxicillin ; Carbamazepine ; Hospitals, General ; Humans ; Ibuprofen ; Indonesia ; Male ; Mortality ; Public Health ; Respiratory Insufficiency ; Retrospective Studies ; Rifampin ; Sepsis ; Stevens-Johnson Syndrome ; Trihexyphenidyl

Urinary incontinence, although rarely reported, is one of the most important adverse effects of antipsychotic medication. It can be an embarrassing, distressing, and potentially treatment-limiting. Several antipsychotics, including both typical and atypical varieties, are known to induce urinary incontinence. Many antipsychotic drugs target the neural pathways controlling continence by binding to receptors of some neurotransmitters such as serotonin, dopamine, acetylcholine, and adrenaline. Pharmacological management of incontinence should be considered if there is a risk of cessation of the antipsychotic therapy or any decline in patients' compliance. Amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl are the most frequently used agents to treat incontinence. We think that the frequency of incontinence is higher than reported in the literature, and that follow-up routines should include a form of standardized screening for all possible adverse effects, including incontinence, of any given antipsychotic. In this article, we report a case of urinary incontinence as an adverse effect of paliperidone palmitate use during maintenance therapy in a patient with schizophrenia.
Acetylcholine ; Amitriptyline ; Antipsychotic Agents ; Cholinergic Antagonists ; Compliance ; Deamino Arginine Vasopressin ; Dopamine ; Ephedrine ; Epinephrine ; Follow-Up Studies ; Humans ; Mass Screening ; Neural Pathways ; Neurotransmitter Agents ; Schizophrenia ; Serotonin ; Trihexyphenidyl ; Urinary Incontinence* ; Paliperidone Palmitate

Acute Disease ; Adult ; Antidotes ; therapeutic use ; Antiparkinson Agents ; therapeutic use ; Benserazide ; Cholinesterase Inhibitors ; poisoning ; Humans ; Insecticides ; poisoning ; Levodopa ; therapeutic use ; Male ; Organophosphate Poisoning ; Parkinson Disease ; drug therapy ; pathology ; Pralidoxime Compounds ; therapeutic use ; Trihexyphenidyl ; therapeutic use

OBJECTIVE: To develop a method to measure trihexyphenidyl, chlorpromazine and clozapine in human blood with GC-MS. METHODS: The specimens were alkalized (pH > 10) and extracted with V (benzene):V(ethyl acetate) = 1:1, and qualitatively analyzed using GC-MS-Full Scan with internal standard SKF525A. The specimens were alkalized (pH > 10) and extracted with V(benzene):V(ethyl acetate) = 1:1, and quantitatively analyzed using GC-MS-SIM with internal standard diazepam-d5. RESULTS: The lowest detection limits of trihexyphenidyl, chlorpromazine and clozapine were 0.3, 0.3 and 0.7 ng/mL (S/N > or = 3) respectively. The calibration curve in 20-10 000 ng/mL showed a good linear distribution. The recovery rate was 79.9% to 85.5%. The RSDs of intraday and interday were less than 5.1%. CONCLUSION The established method was simple, sensitive and accurate for simultaneous determination of trihexyphenidyl, chlorpromazine and clozapine in human blood, and can be applied in forensic toxicological cases.
Adult ; Antipsychotic Agents/poisoning* ; Chlorpromazine/blood* ; Clozapine/blood* ; Female ; Forensic Toxicology ; Gas Chromatography-Mass Spectrometry/methods* ; Humans ; Hydrogen-Ion Concentration ; Male ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity ; Solvents/chemistry* ; Trihexyphenidyl/blood*

OBJECTIVETo assess the effect and adverse reaction of Qufeng Zhidong Recipe (QZR) in treating children's tic disorder (TD).

METHODSWith multicenter randomized parallel open-controlled method adopted, the patients enrolled were assigned to two groups, 41 cases in the Chinese medicine (CM) group and 40 in the Western medicine (WM) group. They were treated by QZR and haloperidol plus trihexyphenidyl respectively for 12 weeks as one course. In total, two courses of treatment were given. The curative effect and adverse reactions were evaluated by scoring with Yale Global Tic Severity Scale (YGTSS), Traditional Chinese Medicine Syndrome Scale (TCMSS), and Treatment Emergent Symptom Scale (TESS), as well as results of laboratory examinations.

RESULTSAfter one course of treatment, the markedly effective rate in the CM and the WM group was 14.6% and 17.5%, respectively, and the total effective rate 43.9% and 47.5%, respectively, which showed insignificant difference between groups (P>0.05). However, after two courses of treatment, markedly effective rate in them was 73.2% and 7.5%, and the total effective rate was 100.0% and 57.5%, both showing significant differences between groups (P<0.05). Besides, the adverse reactions occurred in the CM group was less than that in the WM group obviously.

CONCLUSIONQZR has definite curative effect with no apparent adverse reaction in treating TD, and it can obviously improve the symptoms and signs and upgrade the quality of life and learning capacities in such patients.

Antiparkinson Agents ; administration & dosage ; adverse effects ; Antipsychotic Agents ; administration & dosage ; adverse effects ; Child ; Child, Preschool ; Cookbooks as Topic ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Female ; Haloperidol ; administration & dosage ; adverse effects ; Humans ; Male ; Tic Disorders ; drug therapy ; Treatment Outcome ; Trihexyphenidyl ; administration & dosage ; adverse effects ; Western World