Open AccessUnilateral tremor induced by risperidone in a patient with acute mania: Vitamin B12 deficiency as possible mediating factor
Author(s) -
Shivanand Kattimani,
Sushanta Kumar Padhy,
Indukumar Annamalai
Publication year - 2012
Publication title -
indian journal of pharmacology/the indian journal of pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.286
H-Index - 59
eISSN - 1998-3751
pISSN - 0253-7613
DOI - 10.4103/0253-7613.96355
Subject(s) - risperidone , mania , medicine , vitamin b12 , psychology , psychiatry , pediatrics , bipolar disorder , schizophrenia (object oriented programming) , lithium (medication)
Identification and management of drug-induced movement disorders is a clinical challenge, more so when the clinical presentation is atypical. A young male with acute mania was under treatment with sodium valproate and risperidone. He developed tremors of right hand and neck. These were present at rest and exacerbated by mental activity, when under observation and during voluntarily initiated activity. There were no associated extra pyramidal symptoms or cerebellar signs. Investigations for other common causes of tremors did not reveal any evidence except for low value of serum vitamin B12 levels. The tremors persisted after the withdrawal of valproate, but resolved following the withdrawal of risperidone. It is a common dictum that drug-induced tremors are bilateral. This may not be true always as we found out in our case. These movements were probably induced by risperidone. This atypical presentation could be due to concurrent use of valproate and low serum vitamin B12 levels.