“Clozapine & Valbenazine for Treatment of Tardive Cervical Dystonia: A Case Report”
Tardive Cervical Dystonia
DOI:
https://doi.org/10.46570/utjms.vol11-2023-526Keywords:
Dystonia, antipsychotics, schizophreniaAbstract
Cervical dystonia is a subtype of tardive dyskinesia characterized by smooth, sustained muscle contractions affecting the head, neck, and shoulders. This condition can be caused by antipsychotic medication exposure. It has a significant impact on the patient’s quality of life and represents a treatment challenge for providers. We present the case of a 26-year-old male with a history of schizophrenia treated with antipsychotic medications who presented with on and off smooth twisting movements of his neck and hand tremors. He was initially treated with benztropine and a decrease in the dose of his antipsychotic medications. However, when his symptoms continued to worsen, he was cross tapered to clozapine and valbenazine. Valbenazine is a VMAT2 inhibitor FDA approved for treatment of tardive dyskinesia, but there is little data regarding its use for tardive dystonia. The cervical dystonia impact profile-58 (CDIP-58) was administered to monitor the patient’s symptoms. Overall, there was a reduction in cervical dystonia symptoms within a 10-week period. This case illustrates the potential for clozapine plus valbenazine to treat tardive cervical dystonia.
References
References
Casey D (1990) Tardive dyskinesia. Western journal of medicine 153(5):535.
Burke RE; Fahn S; Jankovic J; Marsden C; Lang AE; Gollomp S, et al. (1982) Tardive dystonia: late?onset and persistent dystonia caused by antipsychotic drugs. Neurology 32(12):1335.
Molho ES; Feustel PJ; Factor SA (1998) Clinical comparison of tardive and idiopathic cervical dystonia. Movement disorders 13(3):486-9.
Godeiro-Junior C; Felício AC; de Carvalho Aguiar P; Borges V; Silva SM; Ferraz HB (2009) Neuroleptic-induced tardive cervical dystonia: clinical series of 20 patients. Canadian journal of neurological sciences 36(2):222-6.
Skidmore F; Reich SG (2005) Tardive dystonia. Current treatment options in neurology 7(3):231-6.
van Harten PN; Kahn RS (1999)Tardive dystonia. Schizophrenia bulletin 25(4):741-8.
Wojcik JD; Falk WE; Fink JS; Cole JO; Gelenberg AJ (1991) A review of 32 cases of tardive dystonia. The American journal of psychiatry 148(8), 1055–1059.
Yassa R; Nair V (1986) Dimitry R. Prevalence of tardive dystonia. Acta psychiatrica scandinavica 73(6):629-33.
Duggal HS; Mendhekar DN (2008) Risperidone-induced tardive pharyngeal dystonia presenting with persistent dysphagia: a case report. Primary care companion to the Journal of clinical psychiatry 10(2):161.
Thenganatt MA; Jankovic J (2014) Treatment of dystonia. Neurotherapeutics 11(1):139-52.
Jinnah HA; Comella CL; Perlmutter J; Lungu C; Hallett M; Investigators DC (2018) Longitudinal studies of botulinum toxin in cervical dystonia: Why do patients discontinue therapy? Toxicon 147:89-95.
Tarakad A. (2020) Clinical Rating Scales and Quantitative Assessments of Movement Disorders. Neurologic Clinics 38(2):231-54.
Loonen AJ; Ivanova SA (2020) Neurobiological mechanisms associated with antipsychotic drug-induced dystonia. Journal of Psychopharmacology 0269881120944156.
Greene P. Treatment of Tardive Dystonia. Therapy of Movement Disorders: Humana, Cham, 2019: 287-9.
Lako IM; van den Heuvel ER; Knegtering H; Bruggeman R; Taxis K (2013) Estimating Dopamine D2 Receptor Occupancy for Doses of 8 Antipsychotics: A Meta-Analysis. Journal of Clinical Psychopharmacology 33(5):675-81.
Touma KTB; Scarff JR (2018) Valbenazine and Deutetrabenazine for Tardive Dyskinesia. Innovations in clinical neuroscience 15(5-6):13-6.
Kilbourn MR; Koeppe RA (2019) Classics in Neuroimaging: Radioligands for the Vesicular Monoamine Transporter 2. ACS Chemical Neuroscience 10(1):25-9.
Uhlyar S; Rey JA (2018) Valbenazine (Ingrezza): the first FDA-approved treatment for tardive dyskinesia. Pharmacy and Therapeutics 43(6):328.
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