Acute Dystonia

Author: Esther Wilson / Editor: Michael John Stewart / Reviewer: Emma Everitt, Philip Delbridge / Codes: A5 / Published: 08/12/2023

Acute dystonia is a common presentation to the Emergency Department (ED). Most cases occur as a result of recreational or prescribed drugs.

After completing this session you will be able to:

  • List the main causes of acute dystonia presenting to ED
  • Explain the pathophysiological mechanisms of acute dystonia
  • Distinguish the important differentials of the diagnosis
  • Identify patient groups most at risk
  • Debate the potential benefits and risks of therapeutic interventions.


  1. Campbell D. The management of acute dystonic reactions. Aust Prescr 2001;24:19-20.
  2. Dressler D, Benecke R. Diagnosis and management of acute movement disorders. J Neurol. 2005 Nov;252(11):1299-306.
  3. Demetropoulos S, Schauben JL. Acute dystonic reactions from “street Valium”. J Emerg Med. 1987 Jul-Aug;5(4):293-7.
  4. Bateman DN, Rawlins MD, Simpson JM. Extrapyramidal reactions with metoclopramide. Br Med J (Clin Res Ed). 1985 Oct 5;291(6500):930-2. doi: 10.1136/bmj.291.6500.930.
  5. Vena J, Dufel S, Paige T. Acute olanzapine-induced akathisia and dystonia in a patient discontinued from fluoxetine. J Emerg Med. 2006 Apr;30(3):311-7.
  6. Peiris RS, Peckler BF. Cimetidine-induced dystonic reaction. J Emerg Med. 2001 Jul;21(1):27-9.
  7. Kapur V, Barber KR, Peddireddy R. Ranitidine-induced acute dystonia. Am J Emerg Med. 1999 May;17(3):258-60. doi: 10.1016/s0735-6757(99)90120-1.
  8. Micheli FE, Pardal MM, Giannaula R, et al. Movement disorders and depression due to flunarizine and cinnarizine. Mov Disord. 1989;4(2):139-46.
  9. Joseph MM, King WD. Dystonic reaction following recommended use of a cold syrup. Ann Emerg Med. 1995 Dec;26(6):749-51.
  10. Hooker EA, Danzl DF. Acute dystonic reaction due to diazepam. J Emerg Med. 1988 Nov-Dec;6(6):491-3. doi: 10.1016/0736-4679(88)90406-4.
  11. Fines RE, Brady WJ, DeBehnke DJ. Cocaine-associated dystonic reaction. Am J Emerg Med. 1997 Sep;15(5):513-5.
  12. Boyer WF, Bakalar NH, Lake CR. Anticholinergic prophylaxis of acute haloperidol-induced acute dystonic reactions. J Clin Psychopharmacol. 1987 Jun;7(3):164-6.
  13. van Harten PN, Hoek HW, Kahn RS. Acute dystonia induced by drug treatment. BMJ. 1999 Sep 4;319(7210):623-6. doi: 10.1136/bmj.319.7210.623.
  14. Nasrallah HA, Churchill CM, Hamdan-Allan GA. Higher frequency of neuroleptic-induced dystonia in mania than in schizophrenia. Am J Psychiatry. 1988 Nov;145(11):1455-6.
  15. Zemishlany Z, Aizenberg D, Weiner Z, Weizman A. Trihexyphenidyl (Artane) abuse in schizophrenic patients. Int Clin Psychopharmacol. 1996 Sep;11(3):199-202.
  16. Dingli K, Morgan R, Leen C. Acute dystonic reaction caused by metoclopramide, versus tetanus. BMJ. 2007 Apr 28;334(7599):899-900.
  17. Arana GW, Goff DC, Baldessarini RJ, Keepers GA. Efficacy of anticholinergic prophylaxis for neuroleptic-induced acute dystonia. Am J Psychiatry. 1988 Aug;145(8):993-6.
  18. Graana N, Ferrea M, Scorticati MC, et al. Beneficial effects of diphenhydramine in dystonia. Medicina (B Aires). 1999;59(1):38-42.
  19. Rainier-Pope CR. Treatment with diazepam of children with drug-induced extrapyramidal symptoms. S Afr Med J. 1979 Mar 3;55(9):328-30.
  20. Herishanu Y, Landau H. Diazepam in the treatment of strychnine poisoning. Case report. Br J Anaesth. 1972 Jul;44(7):747-8.
  21. Ritter MJ, Goodman BP, Sprung J, Wijdicks EF. Ondansetron-induced multifocal encephalopathy. Mayo Clin Proc. 2003 Sep;78(9):1150-2.
  22. Lewis K, O’Day CS. Dystonic Reactions. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. [Accessed Nov 2023].

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