I posted this in the medication section yesterday. I really need some advice, starting to panic that this problem with my child is permanent...is it tardive dyskinesia?

I posted this:

My 10 yr old had 4 days of biphentin 40 mg. Its like Concerta, available in Canada--its methylphenidate. All 4 days he had muscle twitches in his thighs. Now, almost 3 days after stopping the meds, he still has the twitches and they seem to be getting worse but may actually be the same. They come and go and you can actually see them.

Does anyone know how long this will last? Doc says it'll go away but I'm worried. I've been combing the web and cannot find info on how long this will last after stopping, although it is a known side-effect.

He also had stomach aches and did not eat during the day.

Stimulants do not cause TD. They do exacerbate Tic disorders:

http://en.wikipedia.org/wiki/Tic_disorder

TD is often a product of dopamine antagonizing drugs (such as anti-psychotics). SSRI antidepressants (well, probably any one that acts on serotonin) can also supposedly cause TD, though I think this is quite uncommon.

I posted this in the medication section yesterday. I really need some advice, starting to panic that this problem with my child is permanent...is it tardive dyskinesia?

I posted this:

My 10 yr old had 4 days of biphentin 40 mg. Its like Concerta, available in Canada--its methylphenidate. All 4 days he had muscle twitches in his thighs. Now, almost 3 days after stopping the meds, he still has the twitches and they seem to be getting worse but may actually be the same. They come and go and you can actually see them.

Does anyone know how long this will last? Doc says it'll go away but I'm worried. I've been combing the web and cannot find info on how long this will last after stopping, although it is a known side-effect.

He also had stomach aches and did not eat during the day.

Been to Sick Kids?

i also got muscle twitching and eye twitching from my meds. I was on Ritalin.

How long did it last? It has been 5 days since we stopped the meds and he still has it (only took it for 4 days prior to stopping). He never had a tic before.

not yet but if it persists we may have a referral.

I hope that you will continue to keep us posted on how things unfold on that end canukie, and I certainlly hope to hear that things start to improve for your son.

Thank you for the thoughtful reply. Yesterday on another website (can't find it right now) I read that methylphenidate is regarded as an indirect dopamine agonist (antagonist? I could have written it down wrong) as it blocks re-uptake but doesn't bind to the receptors like the anti-psychotics.
He never had a tic before. I'm wondering if the meds triggered some other problem or brought it to the forefront where we could not see it before.

Sorry to hear you are in such distress.

It's hard to say what is happening.

Older Generation Antipsychotics (anti-dopamine drugs) can cause also this sort of muscle movement or jerking, too. (The problem there, though, is called Tardive Dyskinesia, which is basically permanent motor dystonia and extrapyramidal movements.)

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Many varieties of drug reactions (to antipsychotics; demerol; even caffeine) can also cause what are called Dystonic Reactions.

http://www.emedicine.com/emerg/topic157.htm

I saw one of those in full force once (like a seizure, but the person is awake). Very scary. They whole jaw was contorting. BP and HR thru the roof. Seeing a BP of 270/190 and HR of 170 and elevated Temp, is really really scary.
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1.Cogentin sometimes helps with some types of movement disorders or drug reactions.

2.Some Benzos can have muscle relaxant effects too, to stop muscle twitching. (They are also used to prevent/stop seizures, which are also brain-based powerful muscle jerks (myoclonus).)



Other types of 'twitches' can happen too with meds: for example, on Manerix and Effexor, I got blepharospasm (a sort of eyelid twitch). It went away a while after stopping.

The solution may be PARTLY in the "tincture of time".

If it persists, ask for a Sick Kids neurology referral? Maybe they can figure out what is going on...[U]


I'm so glad my doc give me Dexedrine. You never hear of side effects like the ones I'm reading here from these various newer Ritalin and Amphetamine formulations.

The tics should abate eventually. Stimulants do not cause tardive dyskeneisia but they can exacerbate tic disorders. Also, anxiety can make it worse too. If other medications are being taken the culprit may be there as well.

hang in there
Me :D

Thank you Queens U Girl and Speedo. We have been seen by the pediatrician who is stumped by this. In a couple of days if its not resolved I believe she will refer or I will request a referall to a Sick Kids neurologist.

We have never taken any other drugs (other than the odd pain killer and antibiotic and not lately).

I wonder if these slow release drugs can have a faulty mechanism and release more than the expected dose, thus causing an overdose, which this appears to be a symptom of (at least is listed under the over dose symptoms).

Thank you so much for your concern. I will post again with an update.

Happy Holidays!

Thanks to all for listening. I promised to update. We still have twitchy legs but I do feel they are slightly better than before. We saw a neurologist a few days ago. The exam turned up nothing...meaning all is normal except for the legs caused by the (only!) 4 doses of biphentin (methylphenidate). Doc said it was a tic and there was nothing else going on but did not say how long it would last (or whether she had ever seen that side effect before). So I asked, how long? Weeks? Months? She said it was possible. I left feeling very despondent.

Then, later this week I had the wonderful opportunity of seeing Dr. Leonard Sax (see boysadrift.com) in person speak at a school forum. He is touring, promoting a book. He spoke about how (I have to find the source in his book) stimulants affect a part of the brain called the nucleaus accumbens which is responsible for motivation. Basically, taking stimulants over time it makes you lazy. He seemed reasonable. He was not against meds per se.

So after the seminar I asked him about tics that don't go away with stimulant medication. He said very seriously, yes, that happens. I said how long do they last? He said it could be months or years. I pressed and he said it could take a year. I left that evening feeling very despondent as well. However, I feel like it got a straight answer and from someone with experience and knowledge to back it up. He said strattera was a better choice and it didn't damage the brain. (I see there are some nasty side effects with that as well and I'm not jumping on that drug just yet.)

As long as my child is not complaining then I can handle it, and know that it will likely go away. We need to treat these meds with alot of respect. Let this be a warning to all parents!