Objective: Recognizing a drug-induced movement disorder is critical as only stopping using over the counter dopamine-blocking medications such as metoclopramide can reverse or improve clinical manifestations seen in patients. Metoclopramide, one of the commonly used drugs for stomach and esophageal disorders, for nausea and vomiting, can cause drug-induced parkinsonism in one third of patients using it, ranging from mild symptoms to severe movement disorders.

Background: A 47-year-old man is seen in outpatient clinic for headaches. Headache is the main complain he came to see a doctor, however during history taking the patient complained of general stiffness which he referred as arthritis. He has a several-year history of peptic ulcer disease, gastroesophageal reflux disease and osteoarthritis. Current medications the patient is taking are, metoclopramide, proton pump inhibitor, occasional use of analgesics for arthritis and headaches. Family history is remarkable for peptic ulcer disease, rheumatoid arthritis from the father’s side and diabetes and hypertension from the mother’s side.

Methods: On neurological examination the patient is alert and oriented in time, place and person Speech, language, and mental status are normal. Facial expression lacks mimics; the rest of cranial nerve function is normal. Deep tendon reflexes, muscle strength and sensory examination are without abnormalities. Cerebellar function is intact. The rest of the examination is unremarkable. However, slow movements and rigidity are noted in all extremities.

Results: Diagnosis of metoclopramide induced parkinsonism and tension type headache is established and the patient is advised to stop using metoclopramide, appropriate treatment for headaches is prescribed and the patient is also referred to gastroenterologist for further management of peptic ulcer disease and gastroesophageal reflux disease. The patient was followed for the next 3 months. The patient showed improved Parkinsonian features such as stiffness and rigidity were relieved and facial expression also changed. The patient was surprised that his “arthritis” was relieved.

Conclusions: Diagnosis of drug-induced movement disorders is critical because only stopping the drug may reverse or relieve the symptoms. These conditions can often be misdiagnosed or the symptoms may be misinterpreted by the physicians of other specialties as was in this case stiffness and rigidity interpreted as arthritis.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/incidental-finding-of-drug-induced-movement-disorder/