Researchers of a study explored the pathophysiology of extrapyramidal effects (EPS) caused by antipsychotic medications, including the delicate balance between therapeutic effects and extrapyramidal effects. The study reviewed the risk factors for EPS and the different types of EPS, such as acute dystonia, pseudoparkinsonism, akathisia, and tardive dyskinesia. It also outlines the clinical manifestations and management options for each type of EPS, highlighting the importance of differentiating EPS from other conditions, such as neuroleptic malignant syndrome, and emphasizing the need for a thorough physical examination, including cranial nerves assessment, motor examination, gait evaluation, and mental status examination.

In terms of management, researchers suggest using anticholinergic medications, such as benztropine and diphenhydramine, for acute dystonia, and they recommend switching to atypical antipsychotics for pseudoparkinsonism and using medications like amantadine or benzodiazepines for akathisia. For tardive dyskinesia, discontinuing the offending agent and considering alternative medications with lower risk are advised. Preventive measures for EPS, including using low-risk antipsychotics, treating for the shortest duration possible, and providing patient education, are also advised.

Reference: Extrapyramidal Symptoms (EPS): Approach in Primary Care Everyday Health. eMentalHealth.ca. Updated April 3, 2022. Accessed May 15, 2023. https://www.ementalhealth.ca/index.php?m=article&ID=61028