Monday, July 27, 2015

What is Ocular Gyric Crisis(OGC) and the use of Procyclidine

Oculogyric crisis is an acute dystonic reaction of the ocular muscles characterized by bilateral dystonic elevation of visual gaze lasting from seconds to hours. This reaction is most commonly explained as an adverse reaction to drugs such as antiemetics, antipsychotics, antidepressants, antiepileptics, and antimalarials.

Initial symptoms include restlessness, agitation, malaise, or a fixed stare followed by the more characteristically described maximal upward deviation of the eyes in the sustained fashion. The eyes may also converge, deviate upward and laterally, or deviate downward. The most frequently reported associated findings are backwards and lateral flexion of the neck, widely opened mouth, tongue protrusion, and ocular pain. A wave of exhaustion follows some episodes. The abrupt termination of the psychiatric symptoms at the conclusion of the crisis is most striking.

Causes or triggering factors in OGC include: neuroleptics, amantadine, benzodiazepines, carbamazepine, chloroquine, cisplatin, diazoxide, influenza vaccine, levodopa, lithium, metoclopramide, nifedipine, pemoline,  phencyclidine, reserpine, tricyclics, postencephalitic Parkinson's, Tourette's syndrome, multiple sclerosis, neurosyphilis, head trauma, bilateral thalamic infarction, lesions of the fourth ventricle, cystic glioma of the 3rd ventricle, herpes encephalitis, and juvenile Parkinson's

Treatment in the acute phase involves reassurance and treatment with Cogentin (IV or MI)  and/or Benadryl (diphenhydramine) and/or Diazepam or lorazepam. Maintenance therapy with oral forms of the above medications or amantadine  are indicated in more chronic recurrent cases. According to a journal published, procyclidine 5-10mg stat can be given for acute dystonic reaction. From Bluebook, Procyclidine can be given 5 – 10mg stat as a single dose, may repeat after 20mins if needed. (Max:20mg/day)


References:

MyBlueBook

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