How Do I Recognize Extrapyramidal Symptoms?

Extrapyramidal symptoms are disorders of movement associated with malfunctions in a part of the brain known as the extrapyramidal system, responsible for coordinating physical movement. Patients and caregivers need to be alert to the early warning signs of such symptoms because they can become dangerous. Often, the first extrapyramidal symptoms appear in the form of twitching, difficulty keeping still, and involuntary muscle movements. They are usually associated with antipsychotic drugs like haloperidol and amoxapine, but can also sometimes appear in patients with Parkinson's disease and other disorders involving dopamine.

Some patients may develop extrapyramidal symptoms as soon as they start an antipsychotic medication, and they can become very severe in a short period of time. Other patients may use medication for weeks, months, or years before symptoms start to develop. The irregular onset means that patients must always remain alert for warning signs of neurological issues, because they can appear at any time. Care providers in mental health settings are also watchful for early symptoms.

One group of extrapyramidal symptoms known as dyskinesias involve disorders of movement where the patient may make twitching or rolling motions. She cannot control the movements and usually is incapable of sitting still. This can make it difficult to complete tasks. A shuffling, twisting gait can develop, and some patients have difficulty with balance. They may also develop facial tics or twitches that can be highly distracting and could also make it difficult to communicate. Verbal tics like repetition or trouble forming certain words can also become an issue.

Dystonias are another example of extrapyramidal symptoms. These relate to involuntary and abnormal muscle tension that forces patients into awkward and sometimes painful twisted or bent positions. The patient's head may be canted at a funny angle, for example, or the patient could bend over and have trouble straightening up afterward. This can be extremely painful and may cause distress because the patient will have trouble with daily tasks.

One option for managing extrapyramidal symptoms is to change the patient's medication or dosage. Some of these symptoms can be permanent, and it is important to prevent progressive damage. If a drug doesn't work for a patient, a change of treatment may manage the underlying mental health condition without the side effects. A doctor can also prescribe medications to manage the symptoms directly. Patients with Parkinson's, for example, may take a medication known as l-dopa to normalize their dopamine levels and control movement disorders.