Drug Induced Acute Dystonic Paediatric Emergency Admissions In A Southwestern Nigerian Tertiary Hospital

Abstract

Background: Drug-induced acute dystonia is an undesirable, sudden, involuntary movement disorder, following the administration of some drugs. The disorder is studied with the aim of documenting the burden of the disease, the implicated drugs, seasonal variation, and their presentation.

Methods: The records of children seen at the paediatric emergency with acute dystonic reactions between January 2018 and December 2024 were studied. Information retrieved from the records includes age and sex of the children and period in the year seen, presumed culprit drug and the prescribers and dispensers.

Results: A total of 42 admissions with acute drug-induced dystonic reactions were recorded over seven years at the Paediatric Emergency unit of Wesley Guild Hospital, Ilesa, giving a prevalence of 0.005%. They comprised 24 boys and 18 girls giving a male to female ratio of 1.33:1. Their ages ranged between 4 months to 15 years with a mean of 6.75 ± 3.40 years. Majority of the dystonic reactions were focal or segmental involving the posturing or movement of the head and neck region, occurring in 64.29 % of the patients. There were more cases of acute dystonic reaction presenting in the wet season months (84.62%) compared to dry season months. Amodiaquine was the most common drug implicated in ADR followed by Metoclopramide in 45.2%, and 21.4% cases respectively. The dystonic reactions were managed with medications and admission spanning between 1-3 days. Six (14.3%) procured their drug from private hospital and pharmacy, 14 (33.3%) from chemists and maternity centres while the rest did not disclose the source of the medication.

Conclusion: Acute drug induced dystonia is a notable cause of paediatric emergency admission in our health facility and antimalarials, especially Amodiaquine are the commonest drugs implicated. Patients present more in the wet than dry season months. Most cases emanated from self, chemist and maternity nurses' prescription compared with prescription by doctors. Ensuring that these medications are only available, prescribed and dispensed by authorized persons should mitigate the burden of this disease.