Acute Drug-Induced Dystonia in Children

BACKGROUND: Drug-induced acute dystonia is an adverse drug reaction that is concerning in pediatric patients but resolves rapidly with appropriate treatment. In children, data on risky drugs, clinical patterns, and the management of dystonia in the emergency department are limited. This study aimed to evaluate the demographic and clinical findings and treatment outcomes of children presenting to the pediatric emergency department with drug-induced acute dystonia. METHODS: This retrospective observational study includes children aged 1 month to 18 years who were diagnosed with acute dystonia in a tertiary pediatric emergency department between October 2022 and March 2025. The diagnosis was made by a pediatric emergency subspecialist based on clinical findings. Patients were classified according to clinical phenotype as focal/segmental dystonia (group I) and multifocal/generalized dystonia (group II). Demographic data, drug exposures, clinical characteristics, and treatment responses were analyzed. RESULTS: A total of 79 patients were included in the study. The median age was 11 years (IQR: 7 to 16) in group I and 10 years (IQR: 6 to 16) in group II. The most commonly associated drug groups were antipsychotics (55.6%), antiemetics (26.6%), and psychostimulants (20.3%). Focal dystonia is the most common clinical pattern, affecting the head and neck muscles in 61% of cases. The use of metoclopramide was significantly higher in group I (OR: 0.21; 95% CI: 0.04-0.99). All patients were treated with parenteral biperiden. CONCLUSIONS: Antipsychotics and antiemetics are the main triggers of drug-induced acute dystonia in children. Dystonia usually appears within the first 72 hours after starting the drug. It can develop even at therapeutic doses. Dystonias associated with antiemetic drugs often show focal or segmental distribution. Parenteral biperiden is a fast and effective treatment option. Acute dystonia can mimic serious etiologies in the emergency department. Obtaining a detailed drug history can facilitate the diagnostic process.