Hemidistonía como efecto adverso de neurolépticos: A propósito de un caso clínico

Tardive dyskinesias are persistent abnormal movements, occasionally irreversible, that appear during prolonged use of neuroleptics. It is presented the case of a 21-year-old male under follow-up in Mental Health since 2013 with a diagnosis of schizophrenia and on neuroleptic treatment since the age of 13. Two years ago he began to present orolingual dyskinesia and steppage gait; medication was reduced, but no clinical improvement was found. The patient was being treated with aripiprazole and paliperidone, which was reduced due to the appearance of extrapyramidalism, and he was switched to monotherapy with paliperidone depot. In the last months, lurasidone was introduced and depot was discontinued, persisting with gait and speech difficulties. Finally, a diagnosis of hemidystonia secondary to drugs was made. No improvement has been found with muscle relaxants or any of the drugs used and local botulinum toxin and deep brain stimulation have been proposed. The adverse effects of neuroleptics can be expressed with a wide variety of clinical manifestations and are difficult to reverse. In conclusion, prevention by monitoring symptoms every 6–12 months and assessing the risk–benefit of these drugs is important.