TREATMENT OF ACUTE NEUROLEPTIC-INDUCED MOVEMENT-DISORDERS

Acute extrapyramidal syndromes (EPS), including dystonia, parkinsonism , and akathisia, are associated with the use of virtually all neurolep tic agents. They may be alleviated by reducing the neuroleptic dosage, switching to a lower-potency drug, or administering an adjunctive age nt such as an anticholinergic, amantadine, benzodiazepine, or beta-blo cker. Akathisia may be only partly dispelled by anticholinergics; alte rnatives are beta-blockers, benzodiazepines, and clonidine. In patient s receiving long-term neuroleptic therapy, both the prophylactic use a nd the duration of treatment with concomitant anti-EPS drugs are contr oversial. Administration of prophylactic anti-EPS drugs should be base d on the likelihood that the patient will develop EPS, as well as the risk of adverse reactions resulting from extended use of the agents in a specific patient. The decision to continue anti-EPS therapy should be reevaluated frequently, especially in elderly patients.