[A toddler with status dystonicus due to medication]

Abstract

Background: Status dystonicus (SD) is a severe episode of generalized dystonia, potentially complicated by respiratory and metabolic disruption. Triggers can be infection, medication, or metabolic disturbance. The prognosis is variable and mortality is approximately 10%.

Case description: An 18 month old girl presented to the ER with clinical suspicion of a febrile status epilepticus and was evaluated according to APLS principles. Eventually, a SD became apparent, with generalized dystonic features at examination. Most likely, the episode was provoked by a single dose of metoclopramide. Her clinical state improved rapidly, possibly aided by administration of biperiden.

Conclusion: Treatment of SD encompasses elimination or treatment of the trigger, stabilization of vital functions, possible administration of sedatives and dystonia specific medication. Metoclopramide holds a relatively high risk for extrapyramidal complications (1-10%) and dystonia (0.1-1.5%), even within therapeutic range. The use of anti-emetics with less alarming side effect profiles, for example ondansetron, is recommended.