Objective: To describe a case of opisthotonus due to an unusual cause in a young female with complete recovery
Background: Opisthotonus is an abnormal posture due to spastic contraction of the extensor muscles of the neck, trunk, and lower extremities that produces a severe backward arching of the body. It has got varied etiologies including infectious, genetic, metabolic, drug induced etc.
Method: Here we describe a case of acute onset of opisthotonus with an unusual cause and complete recovery.
Results: A 39-year-old diabetic female presented with history of left upper limb tonic posturing and involuntary movements for 3 weeks followed by lateral and backward bending of neck and trunk for 10 days. There was no limb weakness, speech disturbances, or cognitive decline. She had amenorrhea for 2 months. On examination, she had opisthotonus which improved with sensory trick. There was no pyramidal or cerebellar impairment. There was no KF ring and serum ceruloplasmin levels were normal. Her serum prolactin was elevated. MRI brain was normal. She was found to have taken Levosulpiride daily for 1 year for dyspepsia before. It was discontinued and started on trihexyphenidyl and promethazine. She had complete recovery over 2 months.
Conclusion: Levosulpiride is a prokinetic drug with selective D2 inhibition causing dystonia and other extrapyramidal features. Improvement is seen in patients upon discontinuation of the drug, though it is variable. There are many other cases of extrapyramidal side effects of levodopa reported, however no case of opisthotonus caused by levosulpiride is reported in the literature till date.
A detailed drug history should be obtained in any patient with dystonia or other extrapyramidal features to identify any offending drug.
References: 1. Choudhury S, Chatterjee K, Singh R, Shubham S, Trivedi S, Chatterjee S, et al. Levosulpiride‑induced movement disorders: Indian scenario. J Pharmacol Pharmacother 2017;8:177-81.
2. Joe J. Levosulpiride-Induced Neurological Adverse Effects: A Prospective Study from a Tertiary Care Center. Ann Indian Acad Neurol. 2020;23(2):174-176.
3. Radhakrishnan DM, Goyal V. Levosulpiride-induced dystonia: 7 cases. J Assoc Physicians India 2018;66:95–6.
To cite this abstract in AMA style:
A. Rebello, S. A, P. Danda. An Unusual Cause Of Opisthotonus In A Young Female With Complete Recovery [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/an-unusual-cause-of-opisthotonus-in-a-young-female-with-complete-recovery/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/an-unusual-cause-of-opisthotonus-in-a-young-female-with-complete-recovery/