Severe Extrapyramidal Symptoms in a Patient with Niemann-Pick Type C Disease After a Long-Acting Injection of Risperidone.

To the Editors: T here has been clear evidence that patients with Parkinson's disease (PD) have an increased risk of developing extrapyramidal side effects (EPS) from antipsychotic medications. However, there is little evidence in the literature on the risk of EPS for less common neurologic disorders, such as Niemann-Pick type C (NPC) disease. Though there have been rare case reports of EPS in these patients after administration of PO antipsychotics, to date, no cases have provided objective evidence of a causal link. Moreover, there are no reports in the literature of patients with NPC disease developing adverse reactions to long-acting injection (LAI) antipsychotic formulations. We present a case of prolonged EPS in a patient with NPC disease after receiving a LAI of an antipsychotic. Verbal consent for publication of this report was obtained from the patient's mother, who is his surrogate decision maker. The patient in our case was a 28-yearold man with a history of schizoaffective disorder who presented with symptoms of dysphagia, dysarthria, and immobility after receiving a LAI of risperidone at an outside hospital on an unknown date before presentation. Outside medical records revealed that he had previously developed catatonic symptoms and difficulty swallowing after initiating oral risperidone. However, these symptoms were attributed to oversedation rather than EPS, so he was continued on risperidone by the outside hospital with eventual administration of a LAI. When he presented to our hospital, he was initially admitted to the neurology

致编辑：已有明确证据表明，帕金森病（PD）患者使用抗精神病药物出现锥体外系副作用（EPS）的风险增加。然而，文献中关于不太常见的神经系统疾病（如尼曼 - 匹克病C型（NPC））出现EPS风险的证据很少。尽管有罕见的病例报告显示这些患者在口服抗精神病药物后出现EPS，但到目前为止，没有病例提供因果关系的客观证据。此外，文献中没有关于NPC病患者对长效注射（LAI）抗精神病制剂产生不良反应的报告。我们介绍了一例NPC病患者在接受抗精神病药物长效注射后出现长时间EPS的病例。本报告的发表已获得患者母亲（作为其代理决策者）的口头同意。我们病例中的患者是一名28岁男性，有分裂情感性障碍病史，在就诊前于一家外院接受利培酮长效注射（具体日期不详）后出现吞咽困难、构音障碍和肢体活动障碍等症状。外院病历显示，他在开始口服利培酮后曾出现紧张症症状和吞咽困难。然而，这些症状被归因于过度镇静而非EPS，因此外院继续让他使用利培酮，最终给予长效注射。当他到我们医院就诊时，最初入住神经内科。