Category: Drug-Induced Movement Disorders
Objective: To describe a series of patients with levosulpiride (LVS) induced movement disorders (LIM) evaluated at a single movement disorder center, the All India Institute of Medical Sciences, New Delhi, a tertiary care hospital in Northern India.
Background: Levosulpiride (LVS) is a substituted benzamide antipsychotic drug with prokinetic properties [1]. LVS use is associated with extrapyramidal adverse effects because of the central D2 blockades and elderly population is more at risk [2-4]. Despite the increasing use of LVS for dyspepsia and gastric motility disorders, the awareness of LIM is low among physicians and often remains under-recognized and under-reported.
Method: We identified patients with new-onset movement disorder related to LVS through a retrospective review of medical records.
Results: Between 2017 and 2021, 22 patients were diagnosed with LIM. The median age was 64.5 (range 27-82) years and 13 (59.1%) were males. Patients consumed LVS for a median (IQR) duration of 16.5 (30) months. In 14 patients, the daily oral dose was 75 and in the rest, it was 25mg/day. The time to onset of motor symptoms after initiating LVS was 1 week to 2.5 years. The most common LIM was parkinsonism (n=12, 54.5%) followed by focal dystonia (n=8, 36.4%) and lower facial dyskinesia (n=5, 25%); 8 patients had more than one LIM. Akathisia and tremors were observed in two patients each; one patient presented with monosymptomatic bi-brachial action tremor and other had jaw tremors associated with parkinsonism. Asymmetrical parkinsonism-dystonia mimicking corticobasal syndrome (CBS) was seen in one patient. The commonest type of LVS induced dystonia was oromandibular, followed by lingual dystonia. TRODAT scan was abnormal in 2/6 patients with parkinsonism. LIM persisted after withdrawal of LVS in all except one patient with bi-brachial postural tremors. Patients with persistent symptoms were managed with symptomatic therapy, including botulinum toxin for focal dystonia. At a median follow-up of 12 months (range 3-30 months), patients reported 50-60% subjective improvement with therapy.
Conclusion: Conclusion: LVS is associated with major extrapyramidal adverse effects like parkinsonism and tardive syndromes. Symptoms persist even after withdrawal of drug and may be irreversible.
Disclosure: A part of this project has been presented in MDS Congress in 2018. [Levosulpiride Induced Movement Disorder: 7 cases – MDS …
https://www.mdsabstracts.org › Abstracts]
References: 1. Serra J. Levosulpiride in the management of functional dyspepsia and delayed gastric emptying. Gastroenterol Hepatol. 2010;33:586–90.
2. Shin HW, Kim MJ, Kim JS, Lee MC, Chung SJ. Levosulpiride induced movement disorders. Mov Disord 2009; 24:2249 2253
3. Choudhury S, Chatterjee K, Singh R, Shubham S, Trivedi S, Chatterjee S, et al. Levosulpiride-induced Movement Disorders. J Pharmacol Pharmacother. 2017;8:177–81.
4. Joe J. Levosulpiride-Induced Neurological Adverse Effects: A Prospective Study from a Tertiary Care Center. Ann Indian Acad Neurol. 2020;23(2):174-176.
To cite this abstract in AMA style:
D. Radhakrishnan, S. Gomathy, R. Rajan, A. Srivastava, A. Das, A. Agarwal, A. Pandit, V. Goyal. Levosulpiride and Movement Disorders–A Growing Concern [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/levosulpiride-and-movement-disorders-a-growing-concern/. Accessed May 14, 2025.« Back to 2022 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/levosulpiride-and-movement-disorders-a-growing-concern/