Methylphenidate is generally well tolerated, but it often causes sleep disturbances, less commonly suppresses appetite, and may lead to neurological and movement disorders such as tics, dyskinesia, and psychosis. Among movement disorders, acute dyskinesias are particularly rare but clinically significant, as highlighted in recent pharmacovigilance data.Dopamine receptor hypersensitivity and excessive dopamine signaling, disturbances in other neurotransmitter systems, and genetic predisposition are some of the mechanisms thought to contribute to dyskinesia. In the literature, most cases of dyskinesia reported with methylphenidate consist of orofacial and limb dyskinesias or a combination of these. Additionally, acute cases of dyskinesia have been reported following the combined use of methylphenidate and sodium valproate in childhood. To our knowledge, our case is the first case of isolated lingual dyskinesia in which similar drug-related movement disorders are also identified in the family. It is known that the patient’s mother also experienced acute movement disorders after taking psychotropic drugs. Furthermore, the presence of epilepsy diagnosis, sodium valproate use, and multiple neurodevelopmental disorders in our case is noteworthy. While our case demonstrates that dyskinesia can occur even at standard low treatment doses after the first dose, it emphasizes the importance of considering dyskinesia as a potential side effect in cases with a family history of similar drug-related side effects and epilepsy comorbidity.

OBJECTIVE: Autism spectrum disorder (ASD) is a complex neurodevelopmental syndrome with an increasingly prevalent etiology, yet not fully understood. It has been thought that vitamin D, complex B vitamin levels and homocysteine are associated with environmental factors and are important in ASD. The aim of this study was to examine serum vitamin D, vitamin D receptor (VDR), homocysteine, vitamin B6, vitamin B12 and folate levels in ASD. METHODS: In this study, serum vitamin D and VDR, homocysteine, vitamins B6, B12 and folate levels were determined in 60 patients with ASD (aged 3 to 12 years) and in 45 age-gender matched healthy controls. In addition, calcium, phosphorus and alkaline phosphatase, which are associated with vitamin D metabolism, were measured from serum in both groups. ASD severity was evaluted by the Childhood Autism Rating Scale (CARS). RESULTS: Serum vitamin D and VDR were substantially reduced in patients with ASD in comparision to control group. However, homocysteine level was significantly higher and vitamin B6, vitamin B12 and folate were also reduced in patients with ASD. Total CARS score showed a positive association with homocysteine and a negative correlation with vitamins D, B6, B12, folate and VDR. CONCLUSION: This comprehensive study, which examines many parameters has shown that low serum levels of vitamins D, B6, B12, folate and VDR as well as high homocysteine are important in the etiopathogenesis of ASD. However, further studies are required to define the precise mechanism(s) of these parameters and their contributions to the etiology and treatment of ASD.
Alkaline Phosphatase ; Autism Spectrum Disorder* ; Autistic Disorder* ; Calcium ; Child* ; Folic Acid ; Homocysteine ; Humans ; Metabolism ; Phosphorus ; Receptors, Calcitriol* ; Vitamin B 12 ; Vitamin B 6 ; Vitamin D* ; Vitamins*