A Systematic Review of Oral Vertical Dyskinesia (“Rabbit” Syndrome)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Inclusion And Exclusion Criteria
2.3. Data Extraction
2.4. Statistical Analysis
2.5. Definitions
3. Results
3.1. Frequency of RS
3.2. Patient Risk Factors
3.3. Treatment Risk Factors
3.3.1. Typical Antipsychotics
3.3.2. Atypical Antipsychotics
3.3.3. Antidepressants
3.3.4. Psychostimulants
3.3.5. Idiopathic Cases
4. Pathophysiology
4.1. Cases Related to Relative Hypercholinergic and Hypodopaminergic States
4.2. Cases Unrelated to Direct Hypercholinergic and Hypodopaminergic States
4.3. Rabbit Syndrome, Drug-Induced Parkinsonism, and Tardive Dyskinesia
5. Clinical Features
6. Management
7. Differential Diagnosis
7.1. Oral Tardive Dyskinesia
7.2. Horizontal Perioral Movements
7.3. Bruxism
7.4. Oromandibular Dystonia
7.5. Head Tremor in Parkinson’s Disease
7.6. Functional Oral Movements
8. The Missing Link
9. Future Studies
10. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Frequency | N I | Total Sample II | Note | References |
---|---|---|---|---|
4.4% | 6 | 137 | Patients from a psychiatric hospital taking only antipsychotics. | Yassa et al. (1986) [10] |
2.4% | 17 | 716 | Patients diagnosed with several neuropsychiatric pathologies from a psychiatric hospital. | Inada et al. (1991) [12] |
2.0% | 3 | 149 | Only patients diagnosed with schizophrenia from a psychiatric hospital. | Decina et al. (1990) [13] |
1.5% | 1 | 160 | Patients diagnosed with several neuropsychiatric pathologies from a psychogeriatric clinic. | Chiu et al. (1993) [11] |
0% | 0 | 129 | Patients from a psychiatric hospital taking antipsychotics and anticholinergics. | Yassa et al. (1986) [10] |
0% | 0 | 917 | Patients diagnosed with several neuropsychiatric pathologies from a psychiatric hospital. | Chiu et al. (1993) [11] |
0% | 0 | 113 | Healthy elderly individuals from a senior citizen center. | Chiu et al. (1993) [11] |
1.2% III | 27 | 2321 | Total samples |
Medication | Percentage | Number of Patients | Dose (mg/Day) |
---|---|---|---|
Haloperidol | 17% | 18 | 5–30 PO; 260 IM I |
Risperidone | 14% | 15 | 1–6 |
Aripiprazole | 7% | 7 | 10–20 PO; 400 IM I |
Trifluoperazine | 5% | 5 | 5–15 |
Sulpiride | 5% | 5 | 600–1200 |
Escitalopram | 4% | 4 | 10 |
Fluphenazine | 4% | 4 | 20 PO; 25–37.5 IM I |
Olanzapine | 4% | 4 | 10–20 |
Thioridazine | 4% | 4 | 25–100 |
Amisulpride | 3% | 3 | 150–800 |
Levomepromazine | 3% | 3 | 50–150 |
Quetiapine | 3% | 3 | 300–600 |
Amitriptyline | 2% | 2 | 32–75 |
Chlorpromazine | 2% | 2 | 50–150 |
Clozapine | 2% | 2 | 225–450 |
Minoxidil | 2% | 2 | NA |
Paliperidone | 2% | 2 | 3–4 |
Perphenazine | 2% | 2 | 2–8 |
Propericiazine | 2% | 2 | 50–60 |
Bromperidol | 1% | 1 | 20 |
Citalopram | 1% | 1 | 5 |
Clebopride | 1% | 1 | 1.5 |
Clocapramine | 1% | 1 | 100 |
Fluoxetine | 1% | 1 | 40 |
Flupenthixol | 1% | 1 | NA |
Imipramine | 1% | 1 | 150 |
Lithium | 1% | 1 | 600 |
Lofepramine | 1% | 1 | 210 |
Lurasidone | 1% | 1 | 120 |
Methylphenidate | 1% | 1 | 5 |
Mesoridazine | 1% | 1 | 100 |
Oxypertine | 1% | 1 | 60 |
Paroxetine | 1% | 1 | 20 |
Peginterferon alfa-2a | 1% | 1 | 0.18 |
Sertraline | 1% | 1 | 50 |
Zuclopenthixol | 1% | 1 | 200 |
Score | Description |
---|---|
0 | RS was absent even during finger-tapping. |
1 | RS was evident only during finger-tapping. |
2 | RS was present for less than half of the examination time. |
3 | RS was present for more than half of the examination time. |
Disorder | Rabbit Syndrome | Tardive Dyskinesia | Reference |
---|---|---|---|
Movement frequency | Rapid, fine, and usually rhythmic | Slow, irregular (no rhythmicity) | Villeneuve et al. (1972) [1] |
Movement axis | Vertical | All directions | Villeneuve et al. (1972) [1] |
Tongue | No involvement | Usually, involved | Villeneuve et al. (1972) [1] |
Associated abnormal movements | Bradykinesia, tremors, and rigidity | TD affects trunk, neck, and extremities | Villeneuve et al. (1972) [1] |
Attention and voluntary movements, electromyography | Always increases in amplitude and potential frequency | Inconsistent findings | Jus et al. (1973) [3] |
Transitory state from sleep to wakefulness | Persistent | Persistent | Jus et al. (1972) [121] |
Stage I non-rapid eye-movement sleep | Usually persistent, but can be intermittent | Not persistent | Jus et al. (1973) [125] Gangadhar et al. (1981) [27] |
Stages II, III, and IV non-rapid eye-movement sleep | Not persistent | Not persistent | Jus et al. (1972) [121] |
Anticholinergic effect (trihexyphenidyl, benztropine) | Improves symptoms | Worsens symptoms | Sovner et al. (1977) [25] |
Cholinergic effect (physostigmine) | Worsens symptoms | Improves symptoms | Weiss et al. (1980) [26] |
Antipsychotic effect (haloperidol) | Worsens symptoms, but it can be improved | Suppresses symptoms | Gangadhar et al. (1981) [27] |
Antipsychotic withdrawal | Improve symptoms | Initially worsens | Schwartz et al. (2004) [124] |
Vesicular monoamine transporter 2 (VMAT2) effect (speculative) | Likely worsen | Likely improves | Stahl et al. (2018) [126] |
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Rissardo, J.P.; Kherajani, K.; Vora, N.M.; Yatakarla, V.; Fornari Caprara, A.L.; Ratliff, J.; Caroff, S.N. A Systematic Review of Oral Vertical Dyskinesia (“Rabbit” Syndrome). Medicina 2024, 60, 1347. https://doi.org/10.3390/medicina60081347
Rissardo JP, Kherajani K, Vora NM, Yatakarla V, Fornari Caprara AL, Ratliff J, Caroff SN. A Systematic Review of Oral Vertical Dyskinesia (“Rabbit” Syndrome). Medicina. 2024; 60(8):1347. https://doi.org/10.3390/medicina60081347
Chicago/Turabian StyleRissardo, Jamir Pitton, Krish Kherajani, Nilofar Murtaza Vora, Venkatesh Yatakarla, Ana Letícia Fornari Caprara, Jeffrey Ratliff, and Stanley N. Caroff. 2024. "A Systematic Review of Oral Vertical Dyskinesia (“Rabbit” Syndrome)" Medicina 60, no. 8: 1347. https://doi.org/10.3390/medicina60081347