Neurological adverse effects of antipsychotic medication in children and young people

Abstract

Neurological adverse effects (NAEs) are commonly reported in individuals treated with antipsychotic medications. Children and young people (CYP) may be particularly susceptible to these effects, but few studies have focused on the risk of NAEs in this population. This review provides an overview of the published literature on NAEs in CYP with an emphasis on data from randomised placebo-controlled trials. Most antipsychotics are associated with sedative effects that may impair daily functioning. Akathisia, dystonia and parkinsonism are commonly reported in CYP, although rating scale assessments typically show minimal changes from baseline in short-term randomised studies. Tardive dyskinesia appears to be less common in CYP than in adults, but data are limited. Some antipsychotics, in particular clozapine, are associated with a reduced seizure threshold, but it is unclear whether CYP may be more vulnerable than adults and available studies are subject to various confounding factors. Neuroleptic malignant syndrome, a rare and potentially fatal adverse drug reaction, has been reported in CYP treated with both first-generation and second-generation antipsychotics. Data on risk factors and management strategies for NAEs are largely from studies in adults and may not be relevant to CYP. Future studies should aim to resolve some of the current uncertainties. In particular, within-subject “self-controlled” studies using prospectively collected data from large databases would help to clarify the incidence and risk factors, in particular for less common NAEs, while controlling for possible confounders.