Domperidone-Related Acute Dystonia in a Young Child With Underlying Abnormal Electroencephalogram

Domperidone is the preferred treatment for vomiting and gastroesophageal reflux in pediatric population. It is known to have lesser side effects compared to metoclopramide and is rarely associated with extrapyramidal side effects. We report a case of acute dystonia in a 4-year-old girl that occurred after given two doses of domperidone. She initially presented to the emergency department for persistent vomiting and treated with syrup domperidone, ranitidine and oral rehydration salts. Approximately 24 h after last dose of oral domperidone, she developed five episodes of abnormal movement, i.e. stiffness over bilateral upper and lower limbs with eye staring to one direction without blinking. Each episode lasted for less than 10 s and patient did not lose consciousness. No history of head trauma or any family history of neurological diseases was documented. Patient was admitted for workup to rule out seizure. In ward, she developed another two brief episodes of similar presentations which resolved spontaneously without any treatment. No re-occurrence of similar episodes throughout the 3 days of hospitalization was noted. Computed tomography scan of brain confirmed no acute intracranial bleed or focal brain lesion. Electroencephalogram done during subsequent clinic follow-up noted some abnormal records due to increase in slow delta activity, but parents did not consent for magnetic resonance imaging. Patient remained well on biannual follow-up without any seizure or dystonia episode. Rare adverse event involving the central nervous system should be carefully evaluated although product label for domperidone did not mention precaution of use in patients with underlying cerebral abnormalities or epilepsy. Int J Clin Pediatr. 2020;9(2):55-58 doi: https://doi.org/10.14740/ijcp364