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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 20  |  Issue : 1  |  Page : 26-27

Methylphenidate induced tongue movements


Professor and HOD, Department of Psychiatry, Malla Reddy Institute of Medical Sciences, Medchal, Telangana, India

Date of Web Publication20-Jun-2019

Correspondence Address:
Dr. Bhogaraju Anand
Department of Psychiatry, Malla Reddy Institute of Medical Sciences, Medchal, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AMH.AMH_46_18

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  Abstract 


In this paper, we report the case of 7-year-old female, diagnosed wih mild intellectual disability and attention-deficit hyperactivity disorder who developed tongue rolling movements following the use of methylphenidate treatment. The onset of tongue movements started 2½ h after starting methylphenidate and subsided in 3–4 h. Recurrence was noticed only when she was exposed to the medication. This case report highlights the importance of noticing orofacial dyskinesia with methylphenidate use and its discontinuation leading to subsidence of these movements.

Keywords: Methylphenidate, movements, tongue rolling


How to cite this article:
Anand B. Methylphenidate induced tongue movements. Arch Ment Health 2019;20:26-7

How to cite this URL:
Anand B. Methylphenidate induced tongue movements. Arch Ment Health [serial online] 2019 [cited 2019 Sep 18];20:26-7. Available from: http://www.amhonline.org/text.asp?2019/20/1/26/260774




  Introduction Top


Methylphenidate is a drug commonly used in the management of Attention deficiet disorder. An uncommon side effect of tongue.movements is rarely reported in literature.


  Case Report Top


Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder in childhood and stimulant medication such as methylphenidate is commonly used to control the symptoms and to increase their attention span.[1] The common side effects of methylphenidate use reported are: decreased appetite, insomnia, abdominal pain, weight loss, anxiety, irritability, increase in heart rate, and blood pressure and motor tics.[2]

There are some case reports of methylphenidate-induced orofacial dyskinetic movements which occurred immediately after initiation and subsided within few hours and recurred on the repeated challenge.[3],[4],[5],[6],[7]

A 7-year-old girl presented to the psychiatric outpatient department of Malla Reddy Institute of Medical Sciences, Hyderabad with the inability to sit still, restless, picking up objects, beating other children at school, cannot hold her attention for long, for the past 3 years. Developmental history showed a delay in motor milestone development (walking at 18–20 months) and delay in spoken speech (started speaking at 2 years age and poor word formation), but could understand spoken speech. IQ assessment on Binet Kamath test of intelligence was 50.[8] and Berkely and Dupaul ADHD rating scale[9] gave a score of 33 falling into severe ADHD category. A diagnosis of mild intellectual disability with ADHD was made. She was started on tablet methylphenidate Hcl 10 mg to be taken in the morning and speech therapy was advised. She was reported to have tongue rolling movements 2½ h after dosing with methylphenidate noticed soon after its use which sudsided in 3–4 h time. There were no hand or leg movements. These movements occurred every time she was dosed on methylphenidate. Parents discontinued medication by themselves after four such episodes. The patient was brought to the psychiatry outpatient where the investigator also noticed only tongue rolling and longitudinal folding. No other involuntary movements were present. The patient was stopped and switched over to tablet Risperidone 0.5 mg/day. Her ADHD symptoms improved, less restless, can sit for some time and was less stubborn and her ADHD rating scale scores reduced to 20.

In the present case, there is an association between methylphenidate use and the onset of tongue rolling movements which improved after withdrawing the said drug.


  Discussion Top


Methylphenidate blocks dopamine reuptake receptors and increases dopamine agonist activity which is responsible for its therapeutic efficacy. Methylphenidate also increases extracellular dopamine in striatum which could be responsible for abnormal involuntary movements.[10] The peak serum methylphenidate levels reach in about 2 h after oral administration.[11] It is possible that these side effects appear around the peak levels of methylphenidate. Basal ganglia vulnerability has been suggested as a possible mechanism as movement disorder occurs only in certain cases.[12]

This case highlights the importance of clinicians who use methylphenidate regularly, to observe for movement disorders and suggest alternative treatments.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Taylor E, Döpfner M, Sergeant J, Asherson P, Banaschewski T, Buitelaar J, et al. European clinical guidelines for hyperkinetic disorder –First upgrade. Eur Child Adolesc Psychiatry 2004;13 Suppl 1:I7-30.  Back to cited text no. 1
    
2.
Barkley RA. International consensus statement on ADHD. J Am Acad Child Adolesc Psychiatry 2002;41:1389.  Back to cited text no. 2
    
3.
Snell LB, Bakshi D. Neurological adverse effects of methylphenidate may be misdiagnosed as meningoencephalitis. BMJ Case Rep 2015;2015. pii: bcr2014207796.  Back to cited text no. 3
    
4.
Balázs J, Besnyo M, Gádoros J. Methylphenidate-induced orofacial and extremity dyskinesia. J Child Adolesc Psychopharmacol 2007;17:378-81.  Back to cited text no. 4
    
5.
Yilmaz AE, Donmez A, Orun E, Tas T, Isik B, Sonmez FM, et al. Methylphenidate-induced acute orofacial and extremity dyskinesia. J Child Neurol 2013;28:781-3.  Back to cited text no. 5
    
6.
Senecky Y, Lobel D, Diamond GW, Weitz R, Inbar D. Isolated orofacial dyskinesia: A methylphenidate-induced movement disorder. Pediatr Neurol 2002;27:224-6.  Back to cited text no. 6
    
7.
Waugh JL. Acute dyskinetic reaction in a healthy toddler following methylphenidate ingestion. Pediatr Neurol 2013;49:58-60.  Back to cited text no. 7
    
8.
Kamat VV. Measuring Intelligence of Indian Children. 4th ed. Bombay, New York: Oxford University Press; 1967.  Back to cited text no. 8
    
9.
DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD Rating Scales-IV: Checklists, Norms and Clinical Interpretation. New York: Guilford Press; 1998.  Back to cited text no. 9
    
10.
Volkow ND, Wang GJ, Fowler JS, Logan J, Franceschi D, Maynard L, et al. Relationship between blockade of dopamine transporters by oral methylphenidate and the increases in extracellular dopamine: Therapeutic implications. Synapse 2002;43:181-7.  Back to cited text no. 10
    
11.
Kimko HC, Cross JT, Abernethy DR. Pharmacokinetics and clinical effectiveness of methylphenidate. Clin Pharmacokinet 1999;37:457-70.  Back to cited text no. 11
    
12.
Pinter MM, Pogarell O, Oertel WH. Efficacy, safety, and tolerance of the non-ergoline dopamine agonist pramipexole in the treatment of advanced Parkinson's disease: A double blind, placebo controlled, randomised, multicentre study. J Neurol Neurosurg Psychiatry 1999;66:436-41.  Back to cited text no. 12
    




 

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