Antipsychotic drugs can cause extrapyramidal symptoms, such as muscle stiffness and involuntary movements, due to their effect on the dopamine network in the brain. Symptoms can be managed by reducing dosage or switching to newer drugs, while L-Dopa is commonly used to treat disorders affecting dopamine pathways.
The extrapyramidal system is a neural network within the brain that is part of the motor system and has a primary role in coordinating body movements. This system is highly dependent on the neurotransmitter dopamine to function properly. Because many antipsychotic drugs affect the dopamine network, these drugs can cause extrapyramidal symptoms such as muscle stiffness, repetitive muscle movements, and involuntary movements.
Extrapyramidal symptoms, also called EPS, develop primarily due to a disruption of dopamine pathways in sections of the brain involved in the motor system. This disruption leads to a reduced availability of dopamine in the parts of the brain that regulate and coordinate movement. The result is symptoms that relate to loss of muscle control, such as muscle twitching and tremors.
Many types of older antipsychotic drugs cause extrapyramidal symptoms, including haloperidol and chlorpromazine. These drugs work by suppressing the activity of dopamine, which is overproduced in the brains of people with schizophrenia and other psychotic disorders. Extrapyramidal side effects occur due to this dopamine suppression, with the risk of side effects increasing over time as long as the drug is taken.
In some people, extrapyramidal symptoms can occur within hours or days of taking the first dose of an antipsychotic drug; for other people, symptoms may not show up for months or years. Typical side effects include muscle stiffness, tremors, muscle spasms, muscle twitching, involuntary muscle movements, and restlessness. Other common symptoms involve the face and can include drooling, involuntary eye movement, and a mask-like impassive facial expression.
Extrapyramidal symptoms can develop for reasons other than the use of antipsychotic drugs. People with Parkinson’s disease, for example, develop certain types of extrapyramidal side effects due to the death of neurons involved in dopamine secretion. This cell death leads to dysfunction of the extrapyramidal neuronal network and a symptom called bradykinesia, in which movements are performed more slowly than normal.
People who experience extrapyramidal side effects from taking antipsychotic medications may be able to reduce the onset of their symptoms. Typically, symptoms are managed by reducing the dosage of the drug or by switching to another drug. Many newer antipsychotic drugs affect dopamine pathways in different ways, so switching to a newer drug can reduce symptoms. Alternatively, a doctor may prescribe additional medications to reduce the side effects of the antipsychotic drug.
For people with Parkinson’s disease and other disorders that affect dopamine pathways, a dopamine precursor called L-dopa is one of the most common drugs used as a treatment. This drug is used because dopamine itself cannot cross the blood-brain barrier. L-Dopa is able to cross the barrier and as a precursor to dopamine is metabolized into the essential neurotransmitter once in the brain.
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