Metoclopramide Induced Acute Dystonic Reaction in a Child: A Case Report

Metoclopramide is a dopamine receptor antagonist drug that has been used for treatment of a variety of gastrointestinal symptoms. It may also cause a variety of extrapyramidal movement disorders. Acute dystonia is a rare side effect that develops especially in children within the 1st-3rd days of metoclopramide treatment. Acute dystonias usually present themselves as buccolingual, torticollic, oculogyric, tortipelvic, and/or opisthotonic forms. A seven-year-old boy was referred to our emergency department from another hospital with the pre-diagnosis of seizure. A diagnosis of acute gastroenteritis had been made there and treatment with intravenous fluid and metoclopramide (0.5 mg/kg per day in three doses) had been started two days prior. One hour earlier, atypical limb and head movements had begun and seizure was thought to be the cause. Consequently, he was sent to our department for further evaluation. Based on the history and physical examination findings, a diagnosis of acute dystonic reaction was made and biperidene lactate (5 mg) was given. Four hours later, all symptoms had abated. In conclusion, acute dystonic reactions developing due to metoclopramide can be confused with seizures, because of physicians’ unfamiliarity with dystonic movements. Therefore, it is necessary that acute dystonic reactions be considered in differential diagnosis of seizures.