Finally, performing studies on patients struggling with substance abuse and addiction may be particularly challenging due to the frequent psychosocial issues that either precede or result from drug use. Caffeine and pseudoephedrine are known to cause postural and action tremors that closely resemble essential tremor. For example, heroin has been found to be mixed with the synthetic potent opioid fentanyl hydrochloride cocaine with diltiazem and methylephedrine and ecstasy with pseudoephedrine, dextromethorphan and caffeine. In addition, adulterants in drugs of abuse added for the purpose of increasing bulk, enhancing or mimicking a pharmacological effect, or to facilitate drug delivery may themselves cause movement disorders. Toxicity data is derived primarily from individual case reports and small observational case series. The description of disorders associated with drugs of abuse, however, is more challenging.

Similarly, acute alcohol withdrawal may precipitate action tremors involving the hands or other body parts, along with other neuropsychiatric and autonomic disturbances. As an example, beta agonists, lithium and the chronic use of some anticonvulsants may lead to the development of action and postural tremors, and dopamine-blocking neuroleptic and antiemetic medications may trigger acute dystonic reactions and tardive syndromes. Īlthough many movement disorders may develop either in isolation or as part of primary neurologic disease, they may also emerge from the acute use or withdrawal of medications. These terms are defined in the prior version of this review.

In hypokinetic disorders there is absence or paucity of movement that is unrelated to weakness or paralysis, and this suggests parkinsonism.

Hyperkinetic disorders are characterized by an excess of movement, including tremor, dystonia, chorea, myoclonus, tics and akathisia. Movement disorders may be classified according to their primary phenomenology as either hyperkinetic or hypokinetic. 1- MOVEMENT DISORDERS ASSOCIATED WITH ACUTE USE OR WITHDRAWAL OF DRUGS OF ABUSE

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