Oculogyric Crisis Induced by Aripiprazole: An Unwanted But Treatable Side Effect

Background/Purpose: Oculogyric crisis (OGC) is a rare neurological condition characterized by sustained, conjugate, dystonic eye movements, typically involving an upward gaze, lasting from minutes to hours. OGC has been associated with various conditions, including hereditary movement disorders, in particular dopamine metabolism defects (e.g., aromatic L-amino acid decarboxylase deficiency and tyrosine hydroxylase deficiency). Additionally, it can be induced by several drugs, including neuroleptics, antiemetics, and anticonvulsants, as well as by focal brain lesions.

Methods: We report a case of acute oculogyric crisis in a young male patient following the initiation of aripiprazole.

Results: A 6-year-old boy presented to the emergency department with a persistent upward gaze lasting several hours, accompanied by intermittent retrocollis. Although uncomfortable, he was alert and able to speak. The patient had a diagnosis of attention-deficit hyperactivity disorder and had been treated with dexmethylphenidate (30 mg/day) for the previous 3 years. His father reported that aripiprazole (5 mg/day) had been started 4 days prior to symptom onset. Given the clinical presentation and the timing of medication initiation, an acute, drug-induced OGC secondary to aripiprazole was suspected. The patient was promptly treated with intravenous biperiden (2 mg), resulting in complete resolution of the OGC within minutes. He was monitored for 24 hours posttreatment and remained asymptomatic.

Conclusion: This case underscores the potential for aripiprazole to induce acute OCG in pediatric patients, a rare but treatable side effect. Rapid administration of anticholinergics, such as biperiden, can provide quick relief of symptoms. Clinicians should remain vigilant for this adverse effect when prescribing atypical neuroleptics, particularly in the pediatric population.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
26 September 2025