10.1. Analysis.
Comparison 10 Patient reports/series: number of participants with non‐serious adverse events, Outcome 1 Central nervous system: movement‐related outcomes.
| Central nervous system: movement‐related outcomes | |
|---|---|
| Study | |
| Tics | |
| Adrian 2001 | A case report of a boy aged 10 years referred to a tertiary neurodevelopmental assessment clinic for a second opinion on the management of his ADHD. He started with 20 mg/day of methylphenidate at 7 years of age and gradually increased to 40 mg/day, for 2 to 3 years. Both motor and vocal tics started at 40 mg/day of methylphenidate and subsided spontaneously after a year of treatment Authors' conclusion: The clinically explosive outbursts of tics were coincident with a period of treatment with methylphenidate for the treatment of ADHD (attention deficit hyperactivity disorder) and should not be mistaken for a symptom of the disorder |
| Chandler 1989 | Reported non‐serious adverse events. After a month, the child's mother reported motor and phonic tics again. He was treated first with methylphenidate and then with nortriptyline. With both drugs he manifested severe facial grimacing and phonic tics; apparently, the tics had only occurred in the past when the child was treated with methylphenidate. It is, however, very difficult to attribute the tics to methylphenidate with any certainty because of the common co‐occurrence of tics in children and young people with ADHD Key conclusions of the study authors: Side effects, such as hypomania, hyperreflexia and diaphoresis, have been reported in patients being treated with a combination of a monoamine oxidase inhibitor and tryptophan. By itself, L‐tryptophan may be mildly sedating. In light of such a favourable side‐effect profile, combined with no evidence for adverse interaction with stimulants, and at least some rationale from preclinical research, it should be investigated further as a means of alleviating some of the harsh consequences of psychostimulant treatment in ADHD |
| Involuntary movements or dyskinesia | |
| Hollis 2007 | A case report of acute and transient dyskinesia occurring within hours of taking modified‐release methylphenidate (Concerta XL) in a stimulant‐naïve 7‐year‐old boy who had recently stopped taking risperidone Key conclusions of the study authors: This report is the first of a dyskinesia occurring after a single first dose of methylphenidate in a previously stimulant‐naïve patient after neuroleptic withdrawal. It is also the first to link this effect with modified‐release methylphenidate. The dyskinesia described here consisted of both brief tic‐like movements |
| Machado 2010 | Choreoathetoid movements of orofacial muscles, arms and legs, with transient dystonic postures of the right arm induced by a single dose of extended‐release methylphenidate. Author believes that the immediate response ensuing chlorpromazine prescription argues in favour of a specific role for dopamine receptor antagonists in methylphenidate‐induced chorea |
| McLaren 2010 | The patient experienced spasmodic muscular contractions of his jaw. The staff noticed a forceful jaw closure, contraction and tension, and the patient had difficulties opening his mouth. 50 mg of diphenhydramine was administered intramuscularly and the patient could open his mouth within 30 minutes and with no further dystonia |